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THE CONTROL 
OF SEX INFECTIONS 



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THE MACMILLAN COMPANY 

NEW YORK BOSTON • CHICAGO • DALLAS 
ATLANTA ■ SAN FRANCISCO 

MACMILLAN & CO., Limited 

LONDON • BOMBAY • CALCUTTA 
MELBOURNE 

THE MACMILLAN CO. OF CANADA, Ltd. 

TORONTO 



THE CONTROL 
OF SEX INFECTIONS 



BY 

J. BAYARD CLARK, M.D. 

Fellow of the New York Academy of Medicine; Fellow 

of the American College of Surgeons; Member of 

American Urological Association; American 

Association Genito Urinary Surgeons; 

International Surgical Society; 

Sometime Major Medical 

Corps U. S. Army, etc. 



THE MACMILLAN COMPANY 
1921 

All rights reserved 



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Copyright, 1921, 
By THE MACMILIiAN COMPANY 



Set up and electrotyped. Published, January, 1921 



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PREFACE 

If this small book serves to set in mo- 
tion a little more general thinking in this 
vast domain of human interest, it will have 
accomplished something. It is hoped that 
it will do more, by helping somewhat to 
lift the subject up from the back recesses 
of the mind and bring it forward into the 
daylight of open and purposeful discus- 
sion. 

With due recognition of the motives 
which in bygone days prompted teachers 
and parents to sustain a state of ignorance 
on sexual affairs, I have attempted to 
make clear the fallacy of this old, and what 
we now know to be, costly custom. We 
have long been in possession of sufficient 
knowledge of the child mind and its devel- 
opment to be able to supply it with in- 
formative matter, at such time and in such 
measure as to help rather than hinder the 
child's mental and moral growth. 



vi PREFACE 

If I have criticised society somewhat 
severely for its past attitude toward the 
sexual disease problem, I trust that it will 
be taken as constructive rather than de- 
structive criticism. 

If I have seemed unduly critical of the 
medical profession's part in this large 
human concern I should like to state that 
I have the fullest confidence in that profes- 
sion's responsiveness to any real public 
endeavor which is sincerely aimed at the 
overthrow of this social menace. 

Society has so long disliked to have the 
comfort of its mind or mode of life dis- 
turbed that any contest with these dis- 
eases, which is scientifically rational, may, 
I fear, appear sorely radical. That which 
is simply direct may seem severely dog- 
matic. I believe, however, that if we would 
not strip off altogether the veil of sanctity 
with which we instinctively surround sex 
and its ennobling part played in the normal 
union of man and woman, it is high time 
this subject of the sexual diseases was met 
as it becomes brave men and women to 
meet a mortal enemy. 



PREFACE vii 

It is impossible to pass on without draw- 
ing due attention to the brilliant pioneer 
work of August Forel, Havelock Ellis and 
Prince A. Morrow in this particular field 
of social medicine. In the present after- 
war flare of attention to this subject it is 
to the vision of such men that much of our 
structural effort today owes its ground 
work. 

Though I remain acutely conscious of 
the many shortcomings of this small vol- 
ume, I still trust that it may prove to be in 
some degree suggestive. 

J. B. C. 



CONTENTS 



CHAPTER PAGE 

I Introduction 1 



<c? 



II Underlying Causes of Sexual Diseases 10 

III What the War Has Revealed ... 22 

IV The Role of Alcohol in the Sexual 

Infections and Fecundation ... 39 

"^ y The Prevention of Sexual Infections 44 

VI What Every Boy and Girl Should Be 

Taught 61 

VII The Importance of Universal Train- 
ing to Sexual Health 77 

VIII Systematic Care of the Sexual Infec- 
tions 98 

IX Man's Obligation to Society . . . 125 



THE CONTROL OF SEX 
INFECTIONS 

CHAPTER I 
INTRODUCTION 

It may be stated here, that the subject 
matter of this book was not selected be- 
cause it is a pleasing topic to deal with; 
neither was it chosen because it is a re- 
proach to those who are mainly responsible 
for these disastrous diseases which we could 
get along so very well without ; nor has it 
been picked out because of the world's per- 
fectly obvious neglect of this whole sub- 
ject ; but it was chosen because it is the firm 
belief of many well informed students that 
to-day, with the general interest and the 
sincere and active cooperation of the medi- 
cal profession with society at large, very 
much may be done toward the elimination 
of these truly terrible and insidious dis- 



2 CONTROL OF SEX INFECTIONS 

eases. It is for this reason that the author 
offers this small contribution to the cause. 

In the rush of reconstruction we see the 
mask stripped from the motives of men; 
here sincerity shines, there selfishness and 
greed gain ground. Human nature has not 
changed, it has merely been exposed; yet 
it is only now, before the mortar of a new 
peace period has set, that the corner-stone 
of any new conduct can be laid. 

So much, then, of generalities from which 
each one must descend to his own sphere 
of labor, if the task ahead is not to be neg- 
lected. The sphere of the doctor's work 
like that of many others has been deeply 
changed by the war. With the doctor it 
has been an encouraging change. Up to 
the war he had been shrinking more and 
more into a technical and conventional rut 
along which he pursued his way. The war 
has shaken him out onto the surface of the 
earth again. He becomes once more a citi- 
zen. He has human interests as well as 
scientific. He thinks more of the work of 
the State and its obligations ; of sanitation 
and the general prevention of sickness and 



INTRODUCTION 3 

injury. He even thinks of the physical and 
moral development of his fellow-man and 
the environment which will best bring these 
things about. In this new role then of cit- 
izen as well as scientist the world must 
needs look to the medical man for the suc- 
cess of its sanitation and its protection 
against preventable ills. It is here that we 
may well narrow our discussion to the sub- 
ject matter of this book, — that of the sexual 
diseases, which in themselves represent so 
large a part of the world's preventable ill- 
ness, which even represent no inconsider- 
able part of the world's preventable death- 
roll — both in utero and out of it. And yet 
(and this is what adds a peculiar interest 
to the matter in hand), here is a subject 
which polite society has seemingly not 
cared to meet face on. In fact, up to the 
period of the war this whole subject of sex- 
ual sickness has had in the English-speak- 
ing parts of the world a most singular ca- 
reer. As unmolested monarchs have these 
easily preventable infections marched into 
the innermost circles of society, without 
even arousing academic discussion as to 



4 CONTROL OF SEX INFECTIONS 

their elimination — easy conquerors of an 
easy people. 

Can it be that society feels that the 
medical profession has done all there is to 
be done to forestall this festering and 
flourishing march? In that case the sub- 
ject is really an interesting one. Has so- 
ciety itself qualms as to the disgraceful side 
of these sicknesses? Certainly the pitfalls 
ahead of the young have been strangely 
well shielded from sight, and the whole sub- 
ject of sex secluded by secrecy and sham, 
much as if one generation had something 
very like personal reasons for keeping the 
next generation in the dark. So unmen- 
tionable indeed has this matter been in con- 
ventional circles that even the medical man 
with social aims of his own, — for many a 
good man steps down in the world when he 
thinks he is stepping up, — would carefully 
sink his professional activities with sex- 
ually diseased patients and throw up his 
hands in horror, much the same as anyone 
else, when the danger-line of this topic was 
neared. Thus has the future of our human 
family been dealt with. 



INTRODUCTION 5 

Is it possible that our fashionable charity 
hospitals whose doors have been closed to 
these cases share any of the blame for the 
devastating tragedies of these diseases? 
All these are matters of no small impor- 
tance at this time of social reconstruction. 
And our ministers, and teachers of the 
young; — what has been their activity in 
this vital issue of sexual health and in- 
tegrity while they have been moulding the 
minds and characters of the future mothers 
and fathers of our race? Very suggestive 
are these hints as to why we suffer from 
such a prevalence of these pestilent dis- 
eases, but in the following chapters an 
effort will be made to centre the responsi- 
bility more exactly. 

Who would not be in sympathy with the 
general distaste of this whole vice-ladened 
subject of the sexual sicknesses? Cer- 
tainly only those with vice-ladened minds. 
But does that free society from its obliga- 
tions? Let us hope othe rwise. One ap- 
preciates without effort how much pleas- 
anter it is even for the medical profession 
to exclude as much as possible the thought 



6 CONTROL OF SEX INFECTIONS 

and suggestion of these ills from any 
branch of medicine. Even in urology it is 
pleasanter to follow in our practice the 
course of, for example, the surgical devel- 
opment in that branch, rather than to think 
and work, or call attention to the fact that 
we work in terms of diplococci or wriggling 
spirochetes. But can we be so easily re- 
lieved of that which is disagreeable ? Our 
recent war experience inclines us to think 
not. 

In that branch of medicine dealing with 
the diseases of women — it is not only 
easier, but infinitely more profitable, to 
wait until, let us say, a gonococcus infec- 
tion has developed into a pelvic pus sac 
destroying motherhood and health for the 
woman, also providing a surgical opera- 
tion, than it is to turn our first and best 
energy into work preventive of these con- 
ditions. What a field indeed of medical 
prevention and endeavor the gynecologist 
— the specialist in disease of women — and 
the general surgeon too for that matter, 
has left open — and left behind him, while 
he mined gold dust from the gonococcus. 



INTRODUCTION 7 

In France the peasants seem perfectly 
satisfied to have their dung-heaps piled up 
against the parlor door. They treat the 
matter with a delightful indifference. 
Can the medical profession go on being sat- 
isfied to have this social dung-heap de- 
posited against its own door? If it can, 
posterity will be very apt to deduct some of 
that profession's glory won in other fields. 

Frankly, if we are to meet this common 
enemy of our flesh — and spirit, and van- 
quish him, past tactics will have to go into 
the discard and a newer kind of warfare be 
employed, — a standing-up warfare with 
face forward, and an unmistakably plain, 
purposeful and sincere expression given 
to our will-to-win. 

Let us look for a moment into the merits 
of this term Venereal, with which from 
medieval times we have adorned these dis- 
eases, and see if perhaps our foes cannot 
be more successfully fought under their 
separate and more scientific designations. 

From Venus, the Eoman goddess of love, 
as is perfectly well-known, came the term 
Venereal to be applied to all sores and 



CONTROL OF SEX INFECTIONS 



i i 



issues'' consequent upon sexual inter- 
course. For Gonorrhea, Syphilis and 
Chancroid were then all thought to be but 
different expressions of but one disease. 
That misconception has now been scientifi- 
cally swept away. If then we continue to 
use as a group designation of these three 
different and distinct diseases the term 
Venereal as a means of socially stigmatiz- 
ing those individuals who are infected with 
these maladies, we should not leave out of 
account the numberless members of society 
who while exposing themselves continually 
to these infections, are not infected. Here 
is a discrimination which does not savor 
of justice; and if fair play is not to be a 
factor in a battle for moral betterment the 
laurels of war will not linger long on the 
heads of the victors. Again, with the 
broader social knowledge we now have of 
these diseases we know that they shower 
their curses on the virtuous wife and the 
unknowing babe with the same stern and 
relentless fury as upon the veriest rake. 
Furthermore, we know, that with simple 
precautions and with the use of equally 



INTRODUCTION 9 

simple antiseptic measures the most 
vicious are fully protected from these in- 
fections, while the trusting bride or the 
faithful wife is thrust into a lifetime of 
purgatory, and blinded and otherwise 
blighted babies grow up to useless and 
burdensome lives. Once more, so much for 
the justice of this chastising term, Vene- 
real, which must follow the fouled wife or 
the innocent child oftentimes to the grave. 

The ancients thought the great evil lay 
in acquiring a sexual disease; we now 
know that it is a greater evil to transmit 
it. But the greatest evil of all must lie in 
the callous indifference which allows inno- 
cent women and children to become its vic- 
tims and then bathe their wounds in the 
wormwood of a word which stains their 
character. 

From what we like to call the practical 
standpoint, if we are to follow out a suc- 
cessful campaign against these diseases, 
infected persons and carriers of disease 
should not be driven under cover by the 
fear of an odious term, which too often is 
in no wav deserved. 



CHAPTER II 

UNDERLYING CAUSES OF SEXUAL 
DISEASES 

The mere possession of a rather com- 
plete scientific knowledge of the germ fac- 
tor in relation to these diseases does not, 
it would^seem, lessen in the least their fre- 
quency or persistence. Text-book teach- 
ing of cause, symptoms, pathology and 
treatment, while giving perhaps the best 
instruction for the successful care of the 
individual case, furnishes no clue as to their 
general prevention. It becomes necessary 
then to view their genesis from a different 
angle if any foot-hold is to be gained in a 
struggle aimed at their overthrow. Thus 
it is that one is forced to study the social 
conditions which furnish soil for their 
growth, if the roots of the malady are 
ever to be reached. So closely related are 

our sexual declivities and diseases with our 

10 



CAUSES OF SEXUAL DISEASES 11 

social declivities and disorders that it is 
impossible to study the course of the latter 
without uncovering causes of the former. 
Without further delay then, let us turn our 
attention to these social conditions. 

What may be termed the "hush" system 
will make an excellent opening to the sub- 
ject matter of this chapter. It is that awe- 
some, ubiquitous, frowning "hush" pro- 
nounced like a whispered hiss, whenever 
the subject of the human reproductive func- 
tion in any of its phases is approached 
within the hearing of a "child" under 
twenty-four or five years of age, unless of 
course the "child" is by that time a parent 
itself. This "hush" was no doubt in- 
tended to keep the young "pure" and in- 
nocent and protected from "mistakes" 
which might lead to unfortunate con- 
sequences — shadowy, unrevealed conse- 
quences — perhaps to the contraction of 
some unmentionable state of ill-health, 
which might break out in unsightly sores 
or unredeemable disgrace to the family! 
This in a rough way may serve to illustrate 
the traditional treatment of the matter of 



12 CONTROL OF SEX INFECTIONS 

sex by parents and teachers; a matter 
which each child of course, ferrets out for 
itself in league with its companions, from 
such literature as it can lay its hands on, 
augmented by " stories" which give the 
finishing touch to its education on the 
"physiology" of sex. This "hush" or 
keep-in-the-dark system has been made a 
specialty by the English-speaking people. 
The cost of it in precious health and gen- 
eral moral uprightness has been very great. 
If space permitted, one might rehearse by 
way of illustration some tragic cases in 
both young men and young women, vic- 
tims of the "hush" method of rearing, 
who have come under personal observa- 
tion, and whose bitter experiences could be 
directly laid to the darkness in which they 
had been kept of nature 's ways. 

The direct obligation which rests upon 
the parents of young children should no 
longer be left an uncertainty, and in the 
chapter dealing with what every boy and 
girl should be taught, the parents' part 
will not be omitted. 

From all sides should come nothing but 



CAUSES OF SEXUAL DISEASES 13 

the truth of that which pertains to the 
sexual side of life; for alas! the past 
policy of ministers and teachers in their 
guardianship of the young needs a start- 
ling change. The unsettled moral attitude 
which has influenced them in side-stepping 
this whole subject adds another cause to 
the prevalence of sex disease. 

By this time the perusing physician 
who is trying to find some redeeming point 
of interest in all this setting forth of an un- 
savory subject is wondering why he should 
be called upon to review the perfectly ob- 
vious and well-known fact of parents' and 
teachers' neglect in preparing their chil- 
dren for the sexual pitfalls in their path. 
Why indeed should the medical man be re- 
minded of parents' and teachers' short- 
comings even though it is the beginning of 
such a vast amount of sexual morbidity? 
We will let the answer be straight from 
the shoulder. Because the medical man 
and the medical man alone is the source 
of actual knowledge on this subject. 

What physician is there who has seen 
laid bare by the knife the pelvic contents 



14 CONTROL OF SEX INFECTIONS 

of a woman diseased and destroyed by a 
gonococcus infection — seen her rendered 
sexless by the necessity of the case — seen 
her rendered physically and perhaps men- 
tally unstable by the same token, and who 
has not cried out within himself against 
the injustice of our unbalanced social life? 
What physician is there who has seen a 
number of babies blinded by the same or- 
ganism or the children tainted by syphilitic 
parents, whose very soul has not revolted 
at the sight, and yet, — and yet how little 
have we as doctors taken the fact to heart, 
that we alone are the only ones armed 
with that knowledge which can save so- 
ciety so much, so very much, of this wast- 
age, if we each did our part in the general 
dissemination of the facts in the case of 
these danger points ahead? 

What have our laws done to promote 
morality, or to prevent sexual infections? 
Take the case of professional prostitution 
which many look upon as the most fertile 
source of these infections, which it is not. 
The law aims to suppress and dislodge and 
thus finally to extinguish prostitution; and 



CAUSES OF SEXUAL DISEASES 15 

it does not do it. The records of such ac- 
tion in all countries and for all recorded 
time shows prostitution still in a flourish- 
ing condition. One may almost say that it 
grows lusty on the processes of laws to 
abolish it. Some of the mightiest emper- 
ors who, it is said, tried to enforce such 
regulations could not themselves always 
obey their own moral ordinances. It is so 
much easier to make laws to regulate con- 
duct than to go to the bother of bringing 
up the young from birth with a sense of 
respect, let us even say reverence if you 
choose, for honesty and order and morality. 
What was it the ancient Jesuit priests used 
to say? "Give us a child until it is seven 
and you can have it after that." They 
knew when the corner-stone of life's con- 
duct was laid. In its wisdom the law 
seizes many objects of art and paintings 
as obscene, while the obscenity is in the 
minds which think evil. Obscenity is sub- 
jective, not objective. We need not hope 
for reform to come from zeal alone, it 
must be flavored with intelligence. One 
reads that in the State of New York in 



16 CONTROL OF SEX INFECTIONS 

1907 a law was passed rendering any 
one guilty of adultery punishable by six 
months' imprisonment, or a heavy fine, or 
both. It was expected that the law would 
act to prevent adultery. In less than three 
months after this Act became a law, law- 
yers came to the conclusion it was a dead 
letter. In the two years following its en- 
actment there were the usual large number 
of divorces, but only three people were sent 
to prison for a few days under this Act, 
and but four fined a small sum. The 
reader may judge for himself how much 
effect this law had against immorality, or 
what its value was in checking commercial- 
ized vice. The "Baines Law" is another 
enactment with a history. With the idea 
of regulating the sale of liquor it achieved 
the most wholesale prostitution. As a 
learned writer once said, "all the repres- 
sion in the world can only touch the surface 
of life." 

We have mentioned the fact that the pro- 
fessional prostitute is not the greatest 
source of infection. This matter was gone 
into with great care both before and dur- 



CAUSES OF SEXUAL DISEASES 17 

ing the war, and it was found, notably 
in Great Britain, that only a little more 
than one quarter of the infections in men 
were derived from the professional prosti- 
tute. This is not difficult of explanation, 
as those depending on prostitution for a 
living know much better how to keep them- 
selves free from infection. But from the 
casual participant, the working girl from 
the shop or factory or servant class or 
those who idle at home, the percentage of 
infections was almost three-quarters of the 
total on the tabulations made. This is 
doubly unfortunate as these girls not yet 
cut off from self-respecting sources of sup- 
port still carry the hope of husbands and 
homes. Let us now move backward, as it 
were, and see if we can tell where the re- 
sponsibility rests for this vast group of in- 
fected and oftentimes sexually ruined in- 
dustrial workers who ignorantly spread 
the majority of the sexual havoc to all 
classes of society. First, it is just as well 
to look at some of the facts in the matter. 
In Great Britain, and on a much larger 
scale here in America, in all important in- 



18 CONTROL OF SEX INFECTIONS 

dus trial and commercial centers is seen the 
general employment of women, — young 
women between the ages of seventeen and 
thirty. For it is just these girls in their 
home-making and child-bearing period of 
life who seem to be most profitable to in- 
dustry and its ends. Many interesting 
questions and thoughts come to the surface 
of the mind when one takes in the idea of 
all these thousands upon thousands of 
young women in the flower of maternal 
possibility, losing the opportunity in so 
many instances of home-making and 
motherhood, and thus gaining freedom 
from temporizing sexual experiences, be- 
cause department stores and offices and 
factories can offer to their young and im- 
pressionable natures more bright lights 
and tinsel than the more enduring and 
further-sighted satisfactions of marriage 
can offer. Or are we figuring without our 
host? Is it that there are not enough hus- 
bands for these young women, and that 
they represent only the surplusage of the 
female sex? If this is soi, then by all 
means let us encourage modern industry 



CAUSES OF SEXUAL DISEASES 19 

and commerce to make all the money it can 
out of these girls and to employ these pos- 
sible mothers and help them by hard work 
and excitement to suppress and try to for- 
get their natural instincts. But we find that 
very large numbers of these girls have 
their transitory lovers and at least the 
threshold of their sex instinct is not denied 
expression, and we immediately are curi- 
ous to know why these are denied the full 
satisfaction of nature's most imperative 
demand, that of reproducing. This then 
must bring us a step closer to the truth of 
the answer that we are seeking: that the 
flaw is somewhere in the social system we 
are struggling under if it withholds the 
birthright privilege of mating and beget- 
ting its kind to this very large percentage 
of our people. Let us say then if it is the 
economic factor that cuts off from'*o many 
young people the opportunity to marry 
early and have homes and families it is 
economics gone wrong, as the home is the 
economic as well as the moral keystone of 
the social arrangement we like to call civil- 
ization. If it was possible to set up our 



20 CONTROL OF SEX INFECTIONS 

form of civilization on the basis of the indi- 
vidual and independent home, as we did 
when we were money poor and mechani- 
cally unborn, it would be no impossible task 
to continue it now, barring, of course, some 
costly vanities we have fallen in the way of. 

We find then after this excursion into our 
social conditions that there is a vast deal 
of sexual infection kept moving about by 
reason of the fundamental error of an in- 
dustrial and commercial, or if you like 
social system, which rears such a barrier to 
early marriage and home life, forgetting 
that home life is not only the safest eco- 
nomics, but is the safest and best protec- 
tion against sexual diseases. 

As to the extent of this costly and degen- 
erating plague which destroys so much of 
life's happiness and purpose, some idea 
will be gained through the inventory re- 
vealed by the records of the war. 

To recapitulate, we find the following 
items to be outstanding social factors as 
underlying causes of our sexual diseases. 

(1) The system of silence on matters of 
sex; the parents' responsibility. 



CAUSES OF SEXUAL DISEASES 21 

(2) Maintaining the policy of silence and 
the deception of the young as to the truth 
of sexual affairs, by teachers and ministers. 

(3) The physician's obligation to society, 
how this has been neglected. 

(4) Laws regulating sexual morality; 
and their utter futility. 

(5) Prostitution as a source of infection. 

(6) Alcohol. This is placed in a chapter 
by itself. 

(7) Industrialism which might well have 
been treated separately in a special chap- 
ter; and of which more will appear later. 



CHAPTER III 

WHAT THE WAR HAS REVEALED 

This chapter would be a considerable 
volume in itself were it to contain in any 
degree of detail the story of the costly 
consequences laid upon the world by the 
sexual diseases in the war from which we 
are just emerging. In periods of peace a 
vast deal of human energy can escape with- 
out much attention being attracted to it; 
but in a period of mortal conflict where 
every ounce of available man power is 
needed our senses are soon sharpened to 
detect the loss of fighting force which may 
cost us everything we are fighting for. So 
it was through expediency, we must con- 
fess, rather than through any commendable 
sense of morality, that we came upon a 
very dramatic exposure of society's inner 

structures. 

22 



WHAT THE WAR HAS REVEALED 23 

Rather than go into statistical complexes 
to illustrate the dimensions of this social 
shame which our indifference in the past 
has so successfully fertilized, our purpose 
here will be satisfied if by contrasts rather 
than counts (although a few figures will be 
necessary) a general idea of the degrading 
plague we have so placidly entertained, can 
be given, and which the records of our 
recent war experiences have pointed out 
afresh. 

Inasmuch as the structure of society is 
merely a reflection of the individuals in it, 
and that the responsibility for its quality 
rests on each one personally and in propor- 
tion to that one's knowledge, it will soon 
be seen how personally interesting becomes 
the subject matter of this chapter. 

The first jolt to our national pride was 
registered with the initial draft of a million 
men in which Sexual Diseases took first 
place among the infectious conditions met 
with. Of all physical defects save flat foot 
and hernia, which were more numerous, the 
Sexual Diseases as represented by Gonor- 
rhea, Chancroid and Syphilis were the 



24 CONTROL OF SEX INFECTIONS 

commonest conditions of disease or defect 
encountered. 

Through wide-spread educational cam- 
paigns the common evil of tuberculosis has 
become well recognized. This group of 
diseases, — the sexual infections, — was 
found to be even more numerous. 

The question which naturally arises in 
the mind is: Just how numerous were 
they? Quoting the Surgeon-General's Re- 
port of 1919 to the Secretary of War, Vol. 
I, page 48, it reads: "For venereal dis- 
eases during 1917-18, 259,612 cases were 
recorded for enlisted men in the United 
States." There it is, in black and white — 
a record which is probably as accurate as 
has ever been made of these diseases; ac- 
curate at least as a minimum basis, for 
there were at any rate that many recorded. 
Let the reader pause — and if he can, take 
in something of the meaning of these 
figures. High figures in these days we are 
very apt to brush away, as either too com- 
mon or too incomprehensible. Then let us 
think over the potential tragedy of just 
one case and let our imagination carry that 



WHAT THE WAR HAS REVEALED 25 

single one through its possible social rami- 
fications of disease and disgust as it may 
be conveyed from man to woman, from 
woman to child, with its trail of complica- 
tions and catastrophes. And then try and 
conceive a quarter of a million of these 
loathsome diseases in just a given group — 
a sample group if you choose — in a given 
period in a small percentage of our popu- 
lation. It is monstrous, it is almost un- 
thinkable — and yet there it is — the fact. 

But some may think these figures do not 
represent the sexual disease conditions as 
they exist in civil life ; that it was the army 
life which provoked this high percentage. 
Let such minds be disabused, for on the 
contrary the rate of these infections went 
down while the men were in the military 
service. For, for the first time in their 
lives in the almost universal majority of 
cases they were instructed and otherwise 
safeguarded from these infections. In the 
same army report quoted above facts are 
put forth to show as the record reads that 
"Approximately three-fourths of all cases 
that were recorded in the Armv that were 



26 CONTROL OF SEX INFECTIONS 

stationed in the United States during the 
two years were brought into the Army 
from civil life. The Medical Department 
of the army is very careful to leave no 
misapprehension in the mind on that score. 
And it has a right to take a just pride in its 
special work in the prevention of these dis- 
eases which it has been closely following up 
since 1909 when its campaign of preventive 
medicine as applied to sexual infections 
was begun. Unhappily the army does not 
have the same opportunity that is given in 
civil life to influence aright the minds of 
men from birth and to surround them with 
the early home environments which so 
largely determines the after life of every 
individual. 

As showing the result of the physical 
examinations conducted in the draft of the 
second million men from civil life inducted 
into military service the following quota- 
tion from the report made by the Surgeon- 
General to the Senate Committee 1919 will 
be of interest: "This rate of 5.6 per cent, 
for all forms of venereal disease together, 
as shown in the second million men, must 



WHAT THE WAR HAS REVEALED 27 

be taken as the most precise information 
we have concerning the proportion of men 
in the United States, ages 18 to 30, who 
show symptoms of venereal disease at a 
given time." Five and six-tenths per cent., 
which means more than one in every eight- 
een, showed symptoms of infection. There 
is no whitewashing this minimum record 
of facts nor slipping from under that share 
of personal responsibility which rests on 
every citizen of an enlightened country 
who maintains a social state of things 
which made that record possible. But let 
us examine a little more carefully into those 
figures which would stamp one out of 
eighteen of any given group of a million 
of our young men between 18 and 30 with 
a sexual disease. The report reads "who 
shoiv symptoms." Now those who know 
the nature of these diseases — Gonorrhea, 
Syphilis and Chancroid — know that the 
first two — Gonorrhea and Syphilis — which 
are the most important, the most far-reach- 
ing and which represent eighty to ninety 
per cent, of the groups — (Gonorrhea alone 
representing sixty to eighty per cent.) 



28f CONTROL OF SEX INFECTIONS 

know that these diseases have not finished 
their course, nor their infectiousness, nor 
their liability to disabling complications 
simply because they do not show symptoms. 
It is also well known that gonorrhea and 
syphilis run long periods oftentimes when 
they show no symptoms and that only by 
the most searching microscopical and lab- 
oratory tests are we able to demonstrate 
their presence. In all this there is no hos- 
tile criticism of the methods of the draft 
board examiners, for even though they had 
had the experienced men and the necessary 
laboratory equipment at hand they had not 
the time available for the exacting tests 
by which to arrive at the true number of 
sexually infected men passing before them. 
So as a minimum estimate we can take the 
5.6 per cent, as correct for those men who 
were openly and obviously suffering from 
a sexual disease ; but the numbers of gonor- 
and the genitals, external and internal, 
discharge, and where the urine was clear 
and the genitals, external and internal 
(though I doubt if the latter were fre- 
quently examined), gave no obvious evi- 



WHAT THE WAR HAS REVEALED 29 

dence of infection to the sight or touch, 
must have been very great. Personal evi- 
dence of this was given to me in very large 
groups of men pouring into one of the can- 
tonments, who arriving free from any ob- 
vious symptoms of gonorrhea, developed 
active recurrence of all these symptoms 
which might have been quiescent for many 
weeks or even months in civil life, but 
with the radical changes of living condi- 
tions and the burden of unaccustomed ex- 
ercises in drilling and the like were 
brought into evidence again. Of syphilis 
this was not so much the case, but even 
with syphilis there were considerable num- 
bers who, passing the draft board as free 
from, this infection, bloomed out later on 
in camp. All this convinces the writer 
that the percentage of 5.6 is very much too 
low, and that the army is credited with a 
greater number of infections which came 
directly from our civil life plan of sanita- 
tion, and for which the army was in no 
way responsible. 

A very vivid impression of the costli- 
ness of these sexual infections is arrived 



30 CONTROL OF SEX INFECTIONS 

at by the report of the Surgeon-General, 
which gives the time lost by the soldiers 
thus infected. It reads thus: "The loss 
of time for venereal diseases for the year 
(1918) amounted to 3,937,710 days." 
Which disregarding a fraction figures out 
to mean 10,788 years. 

Here is a subject for the enterprising 
social economist to give us some ideas on, 
and if the matter of lost time is carried 
to the estimation of days lost in our civil 
life population owing to these diseases, 
where we can include the wives made life- 
long invalids, the blinded babies which must 
be largely supported for a lifetime, the 
cases of locomotor ataxia, paresis and a 
number of lesser disabling disorders which 
abound in private life and in our State 
supported hospitals and asylums, we shall 
see what an appalling period of time is un- 
necessarily lost, and what a financial bur- 
den the support of these victims of pre- 
ventable diseases we each of us share. 

It makes no difference whether these dis- 
eases are more numerous in the Southern 
States or less prevalent in the Northern 



WHAT THE WAR HAS REVEALED 31 

States. That we have allowed them to 
become so alarmingly prevalent in both 
rural and urban communities both North 
and South is the thing to be kept firmly in 
mind. In this connection it is of no little 
interest to note that acording to the draft 
board findings the increment of sexual in- 
fections was somewhat greater from the 
country than from the cities. 

Early in our war experience it became 
evident to the commander of our forces 
abroad that to send men infected with 
gonorrhea and syphilis overseas would 
only add to our burdens and overtax 
France where accommodations and fuel 
were none too plentiful ; so the orders came 
to send overseas no soldiers thus infected. 
The consequence was that in the camps and 
the ports of embarkation these men were 
continually increasing as they were being 
taken into the service until they were 
banked up, as it were, in camp hospitals 
and quarters and later on in development 
battalions, so called. At some points they 
reached in numbers to many thousands. 
They became embarrassingly numerous, 



32 CONTROL OF SEX INFECTIONS 

and to the government increasingly costly. 
Methods of collective treatment under un- 
favorable circumstances, both as to equip- 
ment and expert care, were slowly set in 
operation. By the autumn of 1918 some 
order was coming out of the former con- 
fusion, and at some points there was 
promise of establishing a uniform and 
scientific form of treatment. Then came 
the armistice. Up went shouts of relief 
from soldiers and citizens, and for a period 
down went discipline and decorum every- 
where. And yet as far as the Sexual Dis- 
ease problem was concerned, there came at 
that moment an opportunity of golden 
rarity. For here on the one hand were 
these thousands upon thousands of sex- 
ually infected soldiers; still in the army; 
still under complete control. On the other 
hand here was the housing and the equip- 
ment and an increasing promise of real 
scientific treatment ready to undo their 
infectiousness and teach them the lesson 
of their danger to the community and to 
themselves, of uncured sexual infection. 
Here was the chance to keep them until 



WHAT THE WAR HAS REVEALED 33 

they were free from infection and then 
send them back to their homes and fellow 
men, clean in body, strong in better re- 
solves, — apostles of a new view of health 
and decency, to take with them everywhere 
they went. I have no doubt more than one 
saw this moment of opportunity which 
would prevent these thousands of active 
volcanoes of infectiousness with their army 
restraint thrown off, from rushing back 
to their civil communities to plant their 
seeds of disease. I have no doubt but that 
more than one wrote earnestly appealing 
to the authorities in Washington to further 
the obvious plan which would safeguard 
the civil communities from the danger 
which the premature release of these in- 
fected soldiers was sure to cause. Nor was 
the Medical Department of the Army at 
Washington unresponsive to appeal or un- 
prepared with a plan to keep these in- 
fected cases until they were free from in- 
fection. Orders were issued that they 
would be restrained and kept under treat- 
ment until, by the usual tests, it was con- 
sidered safe to have them return to their 



34 CONTROL OF SEX INFECTIONS 

homes. The first orders to this effect were 
quite strict. Following orders were a little 
less severe. The other soldiers in the 
camps were rapidly being demobilized. 
It is little wonder that those being retained 
for treatment were restive and ill-satisfied 
with their lot. Perhaps their relatives 
and friends in their home towns let their 
representatives know their anxiety to see 
the boys again. The ranks of infected ones 
dwindled. Perhaps those who were di- 
rectly caring for them had visions of home 
too, and became optimistic over the pro- 
gress toward cure which these multitudes 
of infected men showed. The army got 
smaller. In all departments it went on 
shrinking. Both the well and the sick 
seemed steadily to grow less. I have no 
doubt that some of these sexually diseased 
were rendered non-infectious before they 
were allowed to leave, perhaps a few of 
them were even cured, — but the great op- 
portunity was missed. Politically speak- 
ing, — we slipped by. 

There has already been enough written 
in this chapter to leave a pretty firm belief 



WHAT THE WAR HAS REVEALED 35 

in the fact that the war has given a fairly 
good inventory of our social status as re- 
gards Sexual Diseases; but it has not yet 
given a full account of how much the war 
has increased this highly undesirable stock 
of disease. 

It is impossible to do this for the very 
good reason that the recording of our in- 
crement of these infections in France after 
the signing of the armistice, fell to the 
ground and the inspections so frequently 
held of returning officers and men was a 
form. The true number of those infected 
after the signing of the armistice can never 
be known. It is also impossible because 
we have no records to show the spread of 
these diseases in our civil communities by 
the men we have been referring to, and who 
w r ere released on the public without the 
searching microscopical and other tests es- 
sential to a fair presumption of non-in- 
fectiousness. 

For all that the Medical Department of 
our army stands unique as among our civil 
institutions in the interest and the effort 
put forth by it to cope with sexual in- 



36 CONTROL OF SEX INFECTIONS 

fections; and to the army and navy and 
IT. S. Public Health Service the civil popu- 
lation of this country owes a debt of grati- 
tude for the program devised and the 
methods of instruction pursued; for they 
have put new and valuable knowledge into 
the minds of the army of men who were 
quite innocent of these vital things when 
the Government took them from civil life. 
In Great Britain also a rude awakening 
in this matter of Sex Disease has been dealt 
to its people. During the spring months 
of 1918 I was given the opportunity while 
in England to visit and study at first hand 
a fairly representative number of the hos- 
pitals devoted to the care of soldiers suffer- 
ing from sexual infections. Four years of 
face-to-face experience with these diseases, 
and the consequent distraction of sorely 
needed man-power, had awakened the 
British nation to a new sense of their sex 
disease situation; but they met that situa- 
tion with the same quiet determination and 
purpose which they have shown through- 
out their war experience. If civil life con- 
ditions as regard to these diseases were 



WHAT THE WAR HAS REVEALED 37 

bad in the United States, they were no 
better with the English ; but they were com- 
pelled to call into play more drastic meas- 
ures with which to deal with them. So if 
we find them in the immediate future, as 
present signs indicate, coping with the 
sexual disease problem on a broader and 
more intelligent basis than we in the 
United States are pursuing, we must bear 
in mind that the war imposed more suffer- 
ing in this matter, as it did in every other 
department of life, on our English friends 
across the sea. To derive some idea of 
the number of effectives continuously out 
of action through these diseases, let us note 
the number of hospital beds which were 
provided for them ; early in 1918 there were 
about 20,000 beds and more special hos- 
pitals for their use being built. For, be it 
known, the English had the wisdom to build 
quite early in the war hospitals devoted 
exclusively to these cases, and to these hos- 
pitals properly equipped and well manned 
by expert medical officers the patients were 
directly sent before there was opportunity 
for the mismanagement of their infections 



38 CONTROL OF SEX INFECTIONS 

by unskilled methods. Some of these hos- 
pitals had a capacity of as high as three 
thousand beds — larger by far than the 
largest hospital in New York City. Like 
ourselves here in the United States the 
British have taken up the matter of the 
future prevention of these infections, only 
with the British public it has become a 
burning topic. The English people seem 
at last to see in it the menace that it is 
to national health, happiness and prosper- 
ity, and by public discussion they are work- 
ing out their own problem. 



CHAPTER IV 

THE ROLE OF ALCOHOL IN THE 

SEXUAL INFECTIONS AND 

FECUNDATION 

There is little doubt that the majority 
of sexual infections in the male have been 
contracted under the influence of alcohol. 
Not deeply under the influence of alcohol, 
but enough so that temporarily the hold 
is lessened upon the steering gear of con- 
duct; so that the judgment is blurred and 
undue risks are taken ; and subsequent pre- 
cautions of disinfection are neglected. To 
the vast consequences of this fact is owed 
the larger number of male sex disease 
carriers. The next process in which alco- 
hol plays a ruinous role is to sufficiently 
blunt the conscience and banish reflection 
so that the infected male transfers his 
malady. 

By aid of alcohol men are often enabled 

39 



40 CONTROL OF SEX INFECTIONS 

to induce girls to take the first sexual step. 
This again may be complicated by the con- 
ditions just referred to where an infected 
man is the seducer. 

Thus it would seem that to alcohol a mul- 
titude of miseries are due. 

To those who are under treatment for 
a sexual infection, notably gonococcus in- 
fection or syphilis, the ingestion of alco- 
holic drinks works the greatest harm. The 
value of the treatment may be entirely 
vitiated, and more, the disease is very 
likely to be increased, or new complications 
developed. It is not yet entirely certain 
that the larger number of cases of loco- 
motor ataxia and paresis are not induced 
by the toxic influence of alcohol added to 
the processes of the spirochaeta. So it is 
not difficult to deduce that in the realm of 
sexual infections alcohol is a baneful fac- 
tor. Can it be also that the toxic influence 
of alcohol changes the early resistance of 
the healthy tissues so that in the presence 
of the gonococcus or the spirochaeta these 
organisms more readily gain a foothold? 
This is a question of no little importance. 



THE ROLE OF ALCOHOL 41 

That alcohol has a depraving effect on 
the genetic sense is seen by its ability to 
turn sexual appetite to sexual phantasy, 
and thus on to sexual perversion in those 
with latent tendencies in this direction. 

But what is of the greatest consequence 
and perhaps of broader significance than 
anything yet attributed to alcohol is the 
part it plays in Fecundation. Although 
this subject at first glance may seem to be 
somewhat apart from the care and control 
of sexual infections it is in reality very 
intimately related to these questions; for 
w T ith a sufficiently thick sprinkling of con- 
genially subnormal children destined to 
grow up to be uncontrolled men and women, 
it is useless to hope to achieve the preven- 
tion of any social evil. For data regard- 
ing this subject I shall quote from Forel, 
the famous Swiss psychiatrist, in his book 
on the Sexual Question in which he says in 
regard to the relative evil of alcohol : 
"But what is of much greater importance 
is the fact that acute and chronic alcoholic 
intoxication deteriorates the germinal pro- 
toplasm of the procreators." He then 



42 CONTROL OF SEX INFECTIONS 

calls attention to the Swiss census of 1900, 
in which there figured nine thousand idiots, 
and after careful examination of the bul- 
letins concerning them, it was shown that 
there were two acute annual maximum pe- 
riods for the conception of these idiots, 
calculated back nine months from birth; 
the periods of carnival and vintage, when 
the people drank most. "In the wine- 
growing districts the maximum conception 
of idiots at the time of vintage is enormous, 
while it is almost nil at other periods. 
Moreover, these two maximum periods 
come at the time of year when conception 
is at a minimum among the rest of the 
population; the maximum of normal con- 
ception occurring at the beginning of 
summer." 

"The offspring tainted with alcoholic 
blastophthoria suffer from various bodily 
and physical anomalies, among which are 
dwarfism, rickets, a predisposition to 
tuberculosis and epilepsy, moral idiocy and 
idiocy in general, a disposition to crime and 
mental diseases, sexual perversions, and 
many other misfortunes." 



THE ROLE OF ALCOHOL 43 

Here indeed is succulent food for the 
thoughtful mind; but it would be rash to 
make the statement that prohibition of al- 
cohol is the solution of these difficulties we 
have just described. 

. It is safe to say, however, that the coun- 
tries which build themselves up and pro- 
gress, and which prevent in no way the 
individual rights of the people, will in the 
presence of alcohol and many other dangers 
reach more rapidly a higher level of civili- 
zation than can nations which wall them- 
selves about with a great physical barrier 
as did China. Nations which prop them- 
selves up through a small governing class 
with barriers to free action, leaving the 
sinews of their character to shrivel and 
decay, finally lose the knack of self -protec- 
tion and real progress. 



CHAPTER V 

THE PREVENTION OF SEXUAL 
INFECTIONS 

A cooperative effort which will embrace 
society from top to bottom, — that is what 
the Prevention of Sexual Infections im- 
plies. 

The employment of any single measure 
cannot be relied upon to accomplish the 
purpose. No groups of measures, no suc- 
cession of steps, no system, no matter how 
wisely evolved or skillfully launched, can 
hope for any success unless the plan is 
approved of by a sympathetic public and 
carried forward with real sincerity. 

No good purpose will be gained by dis- 
guising the fact that the road ahead is a 
long one. Neither need we try to hide 
from ourselves the fact that the road will 
have to be much cleared before we can 

44 



PREVENTION OF SEXUAL INFECTIONS 45 

make any material progress. In other 
words, it will be quite useless to bring new 
measures into play and expect to see them 
operate successfully while the underlying 
causes of our present difficulty still flourish. 
"Kemove the cause and the patient will 
get well/' is as true of society as it is of 
the single individual. Then the methods 
which are instituted for the prevention of 
these diseases will probably carry their 
own weight of usefulness; at the present 
time this is not the case. The necessary 
measures for the removal of the difficulties 
in our way are, for the most part, obvious ; 
it is the purpose of this book to try and 
point out the more important ones. 

In the short chapter dealing with the 
role of alcohol it was made quite plain that 
its unintelligent use constitutes perhaps the 
greatest danger to society, in not only un- 
dermining the germinal cells at conception 
but as a most fertile cause of transmitting 
and complicating sexual diseases. It is 
plain then that a quality of character will 
have to be cultivated which can resist the 
unwise use of alcohol. Especially is this 



46 CONTROL OF SEX INFECTIONS 

so in the United States at present, where 
in certain districts and among certain peo- 
ple the repressive measures of law tend 
to increase its consumption and decrease 
its quality. 

The lack of human consideration in our 
present industrial and commercial life may 
be laid alongside of alcohol ; and these twin 
evils may be looked upon as perhaps the 
two most vital factors in the corruption of 
society in which sexual infection and racial 
degeneration are running a close race. If 
we are going to clear the way and set in 
motion means aimed to do away with de- 
generation and sexual disease, a little 
further study of what has been termed 
"the lack of human consideration" is nec- 
essary. It might also be spoken of in a 
broad sense as development without reflec- 
tion, for we have developed a system which 
has snared the captor as well as the captive. 
By the greedy efforts of many captains of 
industry "big business " has been accom- 
plished, but the human factor in combing 
the globe for wage-workers has been rue- 
fully neglected. So that we have in one 



PREVENTION OF SEXUAL INFECTIONS 47 

half of a composite picture the over-rich 
with their sated families and satellites suf- 
fering from excesses and idleness, hunting 
fresh food for their vanity while trying to 
wrest some satisfaction from the display 
of costly surroundings or some degree of 
public approval from their check-book 
charities. In the other half of the picture 
we see the great masses of industrial work- 
ers which have been rooted up from a 
wholesome rural environment and herded 
into physically unfitting, sex provoking, ex- 
citing and character destroying proximity, 
with practically all individuality extin- 
guished; held by the lure of an easier life 
and busy making the poorest goods for the 
greatest prices. 

These things, it will be found, will be 
real stumbling blocks in the way of such 
measures for the prevention of sexual in- 
fections as we may have to propose. On 
the other hand the chapter on what every 
boy and girl should be taught, and the 
chapter on universal training will deal with 
methods by which it is possible to accom- 
plish a very great deal against these two 



48 CONTROL OF SEX INFECTIONS 

great social evils — alcohol and industrial- 
ism. 

Not to be neglected as a fruitful source 
of sexual infection is prostitution, but to 
fasten our whole attention on getting rid 
of prostitution, even if that were immedi- 
ately possible, would as a means of getting 
rid of these diseases carry us but a frac- 
tional part of the way. Though we may 
look upon prostitution as an unmitigated 
and degenerating evil in every form in 
which it appears, the act of doing away 
with every individual prostitute in exist- 
ence would not cure prostitution; and the 
reason for this is simple, as the constant 
demand for them is almost entirely made 
by men; the number of women who are 
prostitutes of th^eir own volition being 
comparatively small. The stupid steps 
which society takes in hounding these poor 
creatures whom society has itself created, 
while at the same time the male members 
of society who demand and support them 
are never reproached, will furnish interest- 
ing matter for thoughtful study for those 
who can think on a higher level than that 



PREVENTION OF SEXUAL INFECTIONS 49 

on which our police-regulation thinking is 
done. 

It is not the object of this book to go 
into the history of prostitution or to de- 
scribe the methods employed in the creation 
of this ancient profession in its various 
forms. All this has been amply written 
upon, from the favored mistress of the 
rich man down to the forlorn specimens 
of commercialized vice who are virtually 
bought and sold. What concerns us here 
is the care and control of sexual infections 
and to that end our sentiments regarding 
these unfortunate condition-made women 
should be radically reformed and our atti- 
tude toward them humanely altered if we 
hope to erase the sources of infection which 
they represent, and to circumvent the evil 
of prostitution itself ; but this will require 
patience, wisdom, and a broad human un- 
derstanding. 

Morally speaking, the border line of 
prostitution is often obscure and difficult 
to detect, as women who prostitute them- 
selves in marriage for money, or childless 
luxury, will attest; these circumstances 



50 CONTROL OF SEX INFECTIONS 

have earned the title of " fashionable pros- 
titution." The distinction is further con- 
fused by the present-day large class of 
purely pleasure-seeking girls and women 
who shrink from household tasks which 
give the essential physical and educational 
preparation for matrimony and maternity ; 
and with powder and paint taking the place 
of the natural bloom of health and purpose 
these idle imitations of the female sex are 
everywhere in evidence, making their ap- 
peal to the baser side of men's nature. 
If the woman is to fulfill nature's require- 
ments of her, it is just as essential for her 
to have muscular work to do as it is for 
the man. Every nation which fails to ap- 
preciate this necessity must end in extinc- 
tion. The woman should develop bodily 
strength and health so that she may have 
strong, robust and intelligent children, 
and the genuine woman's ideal should 
point to nothing less than this. 

One of the greatest obstacles to our in- 
stituting measures of prevention of sexual 
diseases will be found in the false modesty 
which prevents open discussion of these 



PREVENTION OF SEXUAL INFECTIONS 51 

diseases ; the groundless traditional terror 
that has kept this whole subject locked up 
in the dark. This it will be necessary to 
overcome and this we shall find is possible 
to overcome when a sincere interest is 
awakened and sincere efforts are being 
made in the practical work ahead in which 
all must take some part. Let us go on 
then to the discussion of practical meas- 
ures which can be employed. First and 
foremost is governmental sanction and ac- 
tivity. This is already assured, and in 
proportion to the ability and sincerity of 
the leaders and the backing of congres- 
sional appropriations will its progress be 
marked. It has begun its work with edu- 
cational posters and literature and with a 
number of public clinics for the treatment 
of these diseases. Many of the States 
have formulated campaigns and some are 
fitting in their efforts with those of the 
United States Public Health Service. All 
this has a promising trend, but without the 
live sympathy of the public, and more, 
without an insisting public demand for re- 
sults, these brave beginnings will be very 



52 CONTROL OF SEX INFECTIONS 

apt to simmer down to meaningless forms. 
It will be the part especially of all physi- 
cians, social workers, religious and lay 
teachers and parents to keep abreast, 
through their departments of health, of 
this public service and see that it functions 
to the full need of their community. The 
appalling exposure of our social status 
through war-made records leaves nothing 
less than this in the way of personal re- 
sponsibility. 

What a city or a state department of 
health stands for in relation to the citizen 
should be better and more generally appre- 
ciated by every citizen. It is really not a 
prison to which burly police officers hurry 
off their victims to be vaccinated or vapor- 
ized according to the dyspeptic disposition 
or decision of a doting judge; quite the 
contrary, it is the individual's best public 
friend. It is the citizens ' health club, so 
to speak, set up to ensure and protect the 
good health and therefore the greatest 
happiness of each and all of us ; and it is in 
this light we should come to think of it, 
to encourage it and to make use of it. 



PREVENTION OF SEXUAL INFECTIONS 53 

The press is capable of a vast educa- 
tional assistance in publishing authorita- 
tive information regarding the progress of 
public health work in this field of vital 
public health interest. Too serious is this 
matter to be left festering in the dark any 
longer. Our children have a right to a dif- 
ferent policy than has marked our past per- 
formance in the matter of sexual sickness 
which has snatched the blessings of whole 
sight or clean bodies from so many of 
them. 

There are certain measures which every 
department of health should carry out, and 
be fortified in (where that has not already 
been done) by legal enactment. First, the 
reporting of all cases of Gonococcus In- 
fection, of Syphilis and of Chancroid to 
the Board of Health. This matter should 
not be shirked. These diseases should be 
reported under the name (not initials or 
number) of the patient. At the present 
stage of our social morality these patients 
should not be made to feel more guilty of 
disgrace than the guiltiness of the society 
which has through its neglect suffered such 



U CONTROL OF SEX INFECTIONS 

diseases to be rampant. That these dis- 
eases should be treated by any but author- 
ized physicians, should be illegal. All 
cases of Gonorrhea and Syphilis should be 
followed through their treatment by a 
record. The United States Army form of 
Syphilitic Register should be adopted, and 
a similar register had for Gonorrhea. 
The entire treatment should be recorded 
until a clean bill of health is obtained and 
freedom from infectiousness is determined 
by expert opinion. The completed Regis- 
ters should be filed with the Department 
of Health. No certificate of marriage 
should be issued without a certainty ex- 
isting that there is no sexual infection 
present. 

The act of infecting another with a Sex- 
ual Infection through sexual intercourse 
should be a crime inevitably followed by 
heavy punishment, and with damages for 
the infected individual. This is the most 
important legal measure to be enacted in 
relation to these diseases. 

The crime of conveying Syphilis or 
Gonococcus Infection — especially as a 



PREVENTION OF SEXUAL INFECTIONS 55 

wedding gift — is comparable with murder, 
in that it is capable of destroying both 
health and happiness, without which life is 
worthless. 

The question of medical prophylaxis 
being pursued in civil life seems to have 
become a debatable subject. The argu- 
ment will follow its description. 

Medical prophylaxis as at present em- 
ployed by the army, consists of an equip- 
ment comprising the essentials for the fol- 
lowing treatment prescribed to be carried 
out as soon as possible after exposure to 
disease: — Washing the genital organs and 
surrounding parts with soap and water 
after the bladder has been emptied; 
swabbing the Yv r ashed area with a 1 to 1000 
or 1 to 2000 solution of bichloride of mer- 
cury; a urethral injection of a one or 
two per cent, solution of portargol; rub- 
bing into the genital and surrounding parts 
calomel ointment, thirty per cent. 

If this procedure of prophylaxis is 
promptly and properly carried out the lia- 
bility of infection should be practically nil. 
The antiseptic property of soap and water 



56 CONTROL OF SEX INFECTIONS 

alone, if immediately and carefully used, 
and the urethra having been flushed by 
urination, will in most cases be protective. 

The regular army medical officers, who 
have had by many years the fullest experi- 
ence in prophylaxis, showed by their great 
interest in this form of preventive treat- 
ment their confidence in its effectiveness. 
There is no lack of evidence given in army 
literature as to the protective value of this 
affair if it is done soon enough after an 
exposure to disease. It is most effective if 
performed within one hour; but even if 
done after three or four hours it should 
protect the great majority of cases. 

Another form of prophylaxis has been 
employed, consisting of the essentials in a 
small packet which can be carried in the 
pocket and which gives the theoretical ad- 
vantage of prompt employment ; and which 
would be an actual advantage if used 
properly and promptly, which it rarely 
ever is. The essence of the whole pro- 
cedure is simply an evacuation of the 
bladder, a soap and water washing followed 
by antiseptic applications. 



PREVENTION OF SEXUAL INFECTIONS 57 

The argument seems to be : Can we ad- 
vocate a plan of personal protection which 
tacitly sanctions prostitution? The an- 
swer to that argument is that, if rightly 
employed, it can be made a powerful dis- 
couragement to prostitution, besides being 
a public health measure of the widest im- 
portance. 

Only that form of prophylaxis which is 
given in a properly equipped and responsi- 
ble station under the auspices of the Health 
Department should be advocated. The 
personally administered pocket variety is 
not to be recommended. 

It is possible to make a prophylaxis sta- 
tion a social influence of peculiar force. 
From a mature, conscientious, high-class 
man in attendance the applicant can learn 
the dangers and disadvantages which at- 
tend prostitution. He can learn something 
of the general disaster following in the 
train of sexual infections, and the great 
burden of cost which it involves. Without 
preaching morality to him he will see the 
sense of the campaign against these dis- 
eases and perhaps become a disciple of the 



58 CONTROL OF SEX INFECTIONS 

cause. Such stations should be kept as 
clean and orderly as an operating room 
should be kept, a lesson in cleanliness and 
order will thus be conveyed and results will 
be enhanced. Eecords should be kept of 
the time of exposure to disease and time of 
treatment. If more than three hours has 
elapsed since exposure the patient should 
return for observation every other day for 
a week, and then once a week for a month 
so that he can obtain the benefit of the 
earliest possible treatment in the event of 
the development of disease. 

Probably one station of two or three 
treatment rooms would be sufficient in 
every twenty-five thousand of inhabitants. 
It is best to have them in hospitals when 
that is feasible. It will be impossible to 
compel the use of these stations in civil 
life as it was in the army; but the army 
and navy having taught the advantages of 
prophylaxis to several million men, their 
economic advantage will soon come to be 
common knowledge. That methods of this 
sort should have to be thought of at all 
is rather more a stain on our citizenship 



PREVENTION OF SEXUAL INFECTIONS 59 

and religion than a reflection on the means 
necessary to improve them. They will 
automatically go out of existence when so- 
ciety has washed its dirty linen, if it ever 
can. 

Our educational opportunities in the pre- 
vention of sexual infections will be spe- 
cifically dealt with in the succeeding two 
chapters. 

The U. S. Army demonstrated a value 
in social measures to diminish sexual temp- 
tation, or more strictly speaking the army 
gave its approval to religious and other or- 
ganizations to station themselves in and 
about army camps in order to entertain 
and enliven the soldiers by a higher minded 
form of amusement and companionship 
than the soldiers were likely to find for 
themselves. There can be no doubt that 
this plan saved from sexual infections 
many men who otherwise would have found 
companions whose acquaintance would 
have undoubtedly resulted in disease. 

In connection with loneliness and sexual 
disease very interesting studies were made 
of this in England where infection was 



60 CONTROL OF SEX INFECTIONS 

found to be so much more frequent among 
territorials on leave than among English 
Tommies on leave who had families and 
friends for companionship. 

So it is we see the underlying causes of 
the sexual infections — the factors which 
furnish the soil and nourishment for these 
insidious weeds of society, the roots of 
which delve so deep below the surface. 
And so it is that we must see that the re- 
sponsibility for these diseases rests on a 
society which, clothed in an ostensible 
righteousness, hurries by indifferent to the 
cost of health and happiness which lies so 
largely in its hands to prevent. 

Thus it becomes necessary to turn to the 
task of social readjustment and mend the 
evils that an industrial haste and alcohol 
and promiscuous sexuality have so firmly 
planted, before the sound sanitary meas- 
ures of prevention, which we have at hand, 
can justify their usefulness. 



CHAPTER VI 

WHAT EVERY BOY AND GIRL 
SHOULD BE TAUGHT 

Here is the site upon which the store- 
house of human knowledge must find its 
foundation — the child mind — if a clear view 
of life for the individual is to be had. 

The most important mind impression pe- 
riod is up to eight or ten years of age. 
Or as a noted educator once said, "a 
child's education begins when it is born 
and ends when it goes to school. " 

One might say the first impressions con- 
stitute the fibres from which the mental 
processes weave their fabric later on; so 
that in life each mind is clothed in coarse 
or cultured dress. 

Two periods of sexual instruction in 
youth are essential: the first before the 
child is conscious of sex ; the second as sex 
awakens. 

61 



62 CONTROL OF SEX INFECTIONS 

The first or early impressions should 
forestall the child's curiosity as to the birth 
of things, or be at about the same time that 
this curiosity asserts itself. What the 
childish mind is anxious to settle is where 
the kittens came from which seems of a 
sudden to occupy the attention of the house- 
hold cat. Of impregnation the little head 
is not at all concerned. 

But it is not necessary to await the cat's 
accouchement before the first lessons are 
installed. As soon as the child can take in 
the fact that from day to day the plant 
grows, the buds appear and then open into 
flowers, it should be led to this observation. 
The subject then of food upon which the 
plant grows can be made a lesson. Thus 
is the child mind gently opened to the ways 
of nature. But that a new plant may grow 
— this wonder is performed before its 
eyes — a seed is planted in the earth, and 
presently the little plant is born. The 
lesson of impregnation, as the child's mind 
will later come to learn its ways in the life 
of fishes or birds or animals, is almost ac- 
complished. 



BOY AND GIRL SHOULD BE TAUGHT 63 

From the seeds that gave forth a new 
plant the small mind can be directed to the 
egg which gives forth a new life. How the 
egg is born from the hen is then made clear, 
and how the egg has grown up inside the 
hen until it is big enough to be born or 
laid is explained. 

This teaching may well be aided by pic- 
tures or diagrams. 

When the child has grasped these simple 
facts of nature it holds a skeleton key as it 
were to practically all the rest. By this 
time the family cat may be almost ready to 
be delivered. The child's attention is di- 
rected to her increased size, and to the 
child's little mind is recalled the hen's ex- 
perience of keeping the egg before it is 
ready to be "born." When the kittens 
make their appearance then there should 
be no undue surprise. And so the way 
opens for larger things. 

These details have not been set down to 
show just what is necessarily the best se- 
quence of natural events for purposes of 
child instruction. They have been thus set 
down to illustrate the child's mental capac- 



64 CONTROL OF SEX INFECTIONS 

ity, and with what tact and gentleness the 
small mind must be initiated into the 
corner stone truths upon which the whole 
sexual structure is later on to be built. 

They have also thus been given to show 
how impersonally, how little hindered by 
the confusion of self-consciousness sex 
matters can be approached, and the impor- 
tant sexual truths can be calmly thought 
of and transmitted. This is the important 
thing just now for until one generation has 
thus been justly instructed we cannot hope 
that parents will reflexly repeat to their 
progeny this vital knowledge. 

Thus then must this first period of sex 
teaching be carried on long before the sex- 
ual life of the child awakens into conscious- 
ness of self. 

From the more obvious events which at- 
tend the reproductive processes of animals, 
that is, the mother carrying her young and 
then putting them forth into the world, the 
child can be given some idea of how (let 
us keep in mind the household cat to illus- 
trate) these kittens grow and are nourished 
by the mother while she is carrying them 



BOY AND GIRL SHOULD BE TAUGHT 65 

and until they are big enough to look out 
for themselves and be fed by their 
mother's milk after they are born. 

Then to go deeper into the subject of 
origin the child can be told how it is neces- 
sary for the production of these kittens to 
have a father as well as a mother, for it 
is the father which has the seeds of kittens 
which he must give to the mother before 
the kittens can start to grow up inside of 
her very much as the seed must be planted 
in the earth before the earth will produce 
the small plant as the child earlier ob- 
served. 

From this point of understanding it will 
not be difficult to bring the child to see that 
human beings are to all intents and pur- 
poses like animals in the way they have to 
carry their young inside of them until the 
baby is ready and big enough to be born. 
All of which can be made clear by pictures. 

This theme can be pursued into the realm 
of mother love and tender care of the child 
until it grows up ; and then, after the child 
has become either a man or woman its turn 
to parenthood will come with its opportun- 



66 CONTROL OF SEX INFECTIONS 

ity to have fine healthy children to care 
for and love. 

Nothing but the truth concerning the 
processes of reproduction should be told 
to the child. Why should we ever be em- 
barrassed or hesitate to make clear to our 
own children the most beautiful and most 
wonderful of all natural phenomena? 
The answer is simple ; because we did not 
learn these things as wonderful or beauti- 
ful ourselves, or because we are afraid our 
children will discover what is in our minds 
instead. 

If all teachers and parents can feel and 
keep this one following central truth clearly 
in mind, most of the difficulty of teaching 
how nature multiplies will be forever re- 
moved. Nature's sole concern is that we 
do multiply. The small matter of our fool- 
ish self-consciousness is of small moment 
to Nature in her larger task of keeping up 
the race. 

If we are bound on Nature's errand in 
life there will be no occasion for shame in 
the discussion of sexual matters with any- 
one. 



BOY AND GIRL SHOULD BE TAUGHT 67 

It is not to be understood that this teach- 
ing of reproduction is to constitute the sole 
instruction of this period of childhood; but 
it can be taken to mean that this early ob- 
servation and simple nature study com- 
prises the most important elements of be- 
ginning knowledge. Not only is this so 
from the standpoint of necessary informa- 
tion, but because in the young mind facts 
have been deduced from observation, which 
power has exercised and actually set into 
motion that most essential function of the 
.brain — independent thought from personal 
observation. 

It has been contended in writings on so- 
cial hygiene that to teach one child the 
truth about these matters of reproduction 
and then allow that child the companion- 
ship of other children neglected in this re- 
spect and provided only with the fabrica- 
tions of indifferent parents who will not be 
bothered to satisfy that natural childish 
curiosity which is forever putting out in- 
quiry as its small mind gropes after infor- 
mation, will result in a negation of that 
teaching by the group opinions of its fel- 



68 CONTROL OF SEX INFECTIONS 

lows falsely led. Let us not be concerned 
on this score for it is far more likely that 
the single seed of truth fortified by the 
familiarity of personal observation will 
hold its own against the babel of unbacked 
belief and, what is more, may bring about 
conversion unawares. 

It is safe to say that in the case where 
nature's plan of reproduction is clearly 
put, before the child is conscious of its 
sex, that when that sex awakes nature's 
purpose will be plain. Added to this it is 
also safe to say that in the case of normal 
children growing up there is much less 
likelihood of sexual perversions finding a 
foothold. 

But how is this teaching to be brought 
about? It is true, that unless such instruc- 
tion and guidance can be put on a basis 
of universal teaching we shall be very far 
from accomplishing our object. Unless the 
present plan of subterfuge and sham can 
be replaced by truth and an actual effort 
toward enlightenment by longer strides 
than we are making in that direction now, 
the ground-work for preventive measures 



BOY AND GIRL SHOULD BE TAUGHT 69 

aimed at the sexual infections will surely 
fail. 

There seems to be no division of opinion 
among the thoughtful and well educated 
people of the present day that it is the 
child's right to be thus instructed. Neither 
does there seem to be any doubt as to the 
parents' obligation in this matter. But 
how is it to be brought about? Both 
danger and difficulty seemingly lie ahead. 
Without some knowledge of anatomy and 
physiology, without some comprehension of 
sexual psychology, without a little inkling 
of botany, even these simple first period 
lessons on the essential beginnings of life 
will be far from perfect; and the second 
period of instruction at the oncoming of 
puberty will be valueless. 

With the hasty survey that so many of 
these problems get before they are dis- 
carded as out of the question, this problem 
could easily suffer the same eclipse. But 
we shall not allow it to escape us so easily 
as that. Of course the average parent is 
quite ignorant of the scientific facts in the 
case, and almost equally uninformed are 



70 CONTROL OF SEX INFECTIONS 

our institutional teachers. Physicians 
likewise though they may know the scien- 
tific side are inexperienced in the way this 
matter should be set forth; they have 
neither the teacher's art of teaching nor 
the natural parent's deep concern of its 
child's welfare; but the sum of what the 
three (parent, teacher, and physician) pos- 
sess, however, is equal to the occasion. If 
we have the courage of our conviction, that 
it is the child's right to receive protective 
knowledge against disease, disgrace and de- 
generation, then let us see in what way 
we can best provide that necessary instruc- 
tion. What is needed for the first period 
of the child's sex character structure! 

First, a good example set by the parents 
in a cheerful and sanitary home. 

Here already much is being accom- 
plished toward this by the splendid work 
of "community centers" and social work- 
ers. Then should come some such plan of 
child instruction as I have already out- 
lined. Parents must be instructed in this, 
and teachers provided by the local Health 
Departments could be easily trained to 



BOY AND GIRL SHOULD BE TAUGHT 71 

teach the mothers the simple steps of this 
early instruction. Practically no scientific 
knowledge would be necessary beyond the 
explanations which would go with a few 
pictures and diagrams illustrating the 
plant study and anatomical cuts with which 
to make clear the reproductive processes 
of chickens, domestic animals and the 
human plan of carrying the baby before it 
is born. The act of copulation need in 
the child's mind be no more than the act 
of planting the seed, which is all that it is 
in the mind of Nature, so to speak. The 
sexual appetite or desire which imperiously 
demands the male of the species to carry 
out his part in the laws of reproduction by 
depositing the fertilizing sperm in the 
body of the female, does not concern this 
phase of the child's instruction, and right- 
fully belongs to the second period when the 
sexual feelings of the boy or girl are as- 
serting themselves, and when explanations 
of these natural phenomena will be un- 
derstood, and their high purposes appre- 
ciated. 

The normal child before it is seven or 



72 CONTROL OF SEX INFECTIONS 

eight should be able to take in these simple 
but right guiding lessons. 

The tremendous value of satisfying the 
normal child's curiosity with a correct un- 
derstanding of these matters would be hard 
to measure. All the vain searching after 
some reasonable explanation of these phe- 
nomena would be at an end. All the foul 
smirching of the little soul would possess 
its antidote of truth. All the energy lost 
by the searching and smirching would be 
saved for something else. A profound re- 
spect for these wonderful processes of na- 
ture, a wholesome interest in all her ways 
and a beginning sense of its duty to human- 
ity would be the nebulous sentiments form- 
ing in the child's brain. Need we ask: Is 
it worth while? 

Now for a period of years specific sex 
instruction should be omitted. The knotty 
problems of the child have been solved. 
A confidence has been established between 
mother and child which will make the sub- 
ject easy of approach if the young boy or 
girl needs new enlightenment. 

Parents and teachers can turn to the task 



BOY AND GIRL SHOULD BE TAUGHT 73 

of building up character and training the 
child's will, of developing its body and 
storing its mind. 

When the second period of sexual teach- 
ing comes it will require a very different 
treatment. It will be the obligation of the 
parents to keep on the lookout for the ap- 
proach of puberty. The boy now should 
be the special object of the father's obser- 
vations and the mother should watch for 
the girl's oncoming sexual life. 

At this time the father should tell the 
boy that seminal overflow or emissions are 
to be expected and that this is altogether 
a natural thing. The mother should ex- 
plain to the girl what menstruation is, and 
how it is likely to act. But further teach- 
ing than this, at this time of popular igno- 
rance of sex anatomy and physiology, 
should be carried on by the teacher quali- 
fied and trained for this work. It should 
be a part of all school training. Already 
it has been started here and there, but that 
is not enough. A well thought out and sys- 
tematically taught course in the anatomy 
and physiology of sex, with some instruc- 



74 CONTROL OF SEX INFECTIONS 

tion on the sexual infections and other 
pathology, should be made available to 
every boy and girl reaching puberty. As 
mentioned before, it should be the parents' 
care to know when the boy or girl is ready 
for this instruction and then enter them in 
the class. This should not be all: the 
school should also check up the parents' 
part so that no pupil is omitted. 

To start with, these teachers should be 
physicians until the teaching has reached 
a satisfactory standard, when it may pos- 
sibly be passed into the hands of conscien- 
tious lay teachers specially fitted for the 
work. 

The advent of the moving picture has 
made much possible in this field which 
would have been very difficult clearly to 
teach without this aid. 

There should be one course of instruction 
planned to meet the needs of the boys, and 
another for the girls. 

Besides making plain the mechanics so to 
speak of reproduction the sentiments of 
sexual life should be dealt with. Here it 
is that a great good may be accomplished 



BOY AND GIRL SHOULD BE TAUGHT 75 

by setting the standards of sexual affinity 
and faithfulness on the high plane which 
should be their eternal place in the minds 
of men and women. The sexual life should 
be raised up from the low estate to which 
it has unhappily fallen along with so much 
else in our modern madness for material 
things. This instruction of boys and girls 
should do much to frustrate the counterfeit 
affections and vices which modernity has 
thrust upon us. 

The need of hereditary quality — a better 
breed — is painfully evident in the world 
today. There will be no better opportunity 
of impressing this need than at this mo- 
ment of sex teaching and it will do much in 
lifting to a higher level the world's habit 
of thinking in this department of life. 

And we must look more to the women of 
the race in the future to safeguard poster- 
ity. Women are destined to have a larger 
role in the destiny of man than they have 
ever had in the past; and it is time that 
education to that end should be available 
to them. If we are going to have a better 
progeny our present methods and aims of 



76 CONTROL OF SEX INFECTIONS 

sexual selection will have to be much re- 
paired. ' 'Social ' ' advancement, money, 
ease, luxury— these are the moving factors 
in too many of our marital adventures of 
today. And adventures they too plainly 
often prove to be. That many are married 
but few are mated, is all too apparent. 

One has to make but a short excursion 
into this realm of sexual life to see the 
need of sexual instruction if we are to bar 
from the future the bitter fruits of our 
present social depravity, and our sexual 
diseases. 



CHAPTER VII 

THE IMPORTANCE OP UNIVERSAL 
TRAINING TO SEXUAL HEALTH 

Before pointing to any measures for the 
care and control of sexual infections which 
might be advantageously incorporated with 
a national system of training, it will be 
well to look for a moment at universal 
training as a social factor capable of in- 
fluencing the underlying causes of these 
diseases. 

This can best be done by a short review 
of this scheme of training, which in this 
or some similar form is bound in the future 
to be installed as an absolutely necessary 
health and educational, as well as national 
defense, measure for this country. It 
would not be pleasant to have to bring the 
mind to a belief that our national stupidity 
could be so complete as to take any other 
view of the matter. 

77 



78 CONTROL OF SEX INFECTIONS 

A moderate and yet what would seem to 
be an adequate plan for universal military 
training has been formulated, placed before 
Congress and received the commendation 
of the highest military authority as well 
as some of the best minds in the land. 

It has been pointed out that the sixteen 
cantonments built at a huge expense by 
the Government for the training of the re- 
cent national army, would be suitable for 
universal training and the accompanying 
vocational instruction in appropriate 
trades which are as important in time of 
peace as in war. It goes without saying 
that under a system of universal training 
and with a reserve built up thereby only 
a small regular army would be necessary. 
The evils and immoralities of a large 
standing army, or for that matter of any 
sized professional soldier force of un- 
married men, is all too well known. 

The maintenance of a large standing 
army means the maintenance of a large 
permanent professional prostitute class. 
The maintenance of a large professional 



IMPORTANCE OF UNIVERSAL TRAINING 79 

naval establishment means exactly the 
same thing. On that score we should 
know exactly what we are doing if we 
vote down universal training. 

A small professional army only, backed 
by a trained ditizen 'reserve, means the 
possibility of early marriage for the many; 
for universal training would put no bar to 
matrimony as does three or five years' en- 
listment periods in army or navy service. 
Again we should know exactly what we are 
doing when we put obstacles in the way 
of marriage. 

For a fighting force pick out married 
men every time — men with wives and 
homes and family honor to protect. Also 
men who are not liable, to the tune of one 
in twenty, to be unfitted by a sexual dis- 
ease. 

A very brief outline of the plan will 
be all that it is necessary to give here. 
There should be a short period of six 
months' training for the male youth of the 
country on reaching the age of 18 or 19 
years. 



80 CONTROL OF SEX INFECTIONS 

This would be under direct Federal con- 
trol, in either the army or navy as pre- 
ferred. 

For the illiterate and non-English speak- 
ing there would be educational camps for 
a period of three months preceding the 
regular period. Have we not heard some- 
where that about 24.9 per cent, of the young 
men of the country would qualify for this 
preliminary educational advantage? 

It was proposed to naturalize aliens 
automatically who graduated from the 
course of training required. 

All young men on passing out of the 
training camps would for a period of ten 
years be on the reserve list and during the 
first five years have several short periods 
(two or three weeks) of training so that 
they would not forget what they had 
learned ; they would thus remain conscious 
of the responsibility, and so form that habit 
of responsibility of citizenship which with- 
out giving service to one's country is so 
prone to be lacking in periods of peace. 

During this reserve period of ten years 
each young man would have the benefit of 



IMPORTANCE OF UNIVERSAL TRAINING 81 

an annual physical examination and medi- 
cal treatment if necessary. He would 
make also an annual report, thereby realiz- 
ing that he is on the books, as it were, of 
his country and a person of some impor- 
tance, instead of a creature with no indi- 
viduality or identity. The psychological 
result of this is patent. 

It is not the business of this book to 
attempt to influence the intelligent reader 
towards taking a favorable view of this 
project of universal military training in 
order that he will advance its cause, for it 
is unthinkable at the present time that any 
lucid minded citizen is not doing this very 
thing for the perfectly obvious reasons 
which necessitate it, and which are quite 
aside from the advantages which it is the 
object of this chapter to point out. 

Now what are these advantages? 

First and foremost is the socializing fac- 
tor which would carry some real influence 
in the uprooting of the underlying causes 
of these diseases to which reference has 
been made. 

With the results of the modern indus- 



82 CONTROL OF SEX INFECTIONS 

trial and commercial stampede before our 
eyes; where communities are packed with 
these wage-dependent workers, male and 
female ; where marriage is delayed or aban- 
doned and where respect for good manners 
or morals is unheard of and where sexual 
infections have pretty much their own way, 
the time does seem almost ripe to introduce 
into our national society some of the re- 
straining influences of discipline, a regard 
for order and decency, self-control and 
some educational assets. And it is these 
things which form the essence of the well 
conducted army training camp atmosphere, 
from which no normal young man can issue 
forth without bearing the marks of better- 
ment. But what is even more fundamental 
than these are the physical training and de- 
velopment, and the secrets of health which 
whet the appetite for clean, orderly and 
purposeful living. Some self-reliance 
might come to be established in the indi- 
vidual youth and prospective citizen — 
some courage and character which would 
help to pry him loose from the mass de- 
pendence and give him the confidence and 



IMPORTANCE OF UNIVERSAL TRAINING 83 

wit to bargain for his own employment or 
start him off on some individual form of 
livelihood which is even better. 

This era of industrialism which has 
been such a hindrance to human progress 
and such a fertile soil for sexual depravity 
while it has been so busy about its material 
accretions would in part be counteracted. 

Once this fatal habit of dependence on a 
job could be broken, this wage-slave form 
of discontented mind be cured, the out- 
stretched hands to charity withdrawn, and 
in its place the hot blood of self-respect 
and independent manhood set circulating, 
our eyes might now and then be greeted 
by the wholesome sight of a vigorous 
pioneer going forth to claim the treasures 
of the open air and fruitful soil. We 
might even see some of the abandoned 
farms once more peopled by earnest, hon- 
est folk surrounded by their healthy and 
happy children; and with such redeeming 
signs as these a real pride in our nation 
might again be reborn. 

Along with the physical upbuilding, edu- 
cational development and the Americaniz- 



84 CONTROL OF SEX INFECTIONS 

ing influence which universal training 
could bring about, the power to set aright 
the minds of the young men regarding the 
evils of alcohol, opium and other drugs 
could be most effectively impressed. This 
must take no small part in this scheme for 
the national training of our youth if we are 
sincere in the desire to see humanity saved 
from the despoiling influence of these 
poisons. This deeply concerns any effort 
in the weeding out of sexual diseases as the 
chapter on the role of alcohol in relation 
to these maladies pointed out; and the re- 
sults of teaching the youth of the country 
as they come to their term of training, will 
be greater, I believe, than the results of 
prohibiting the manufacture and sale of 
alcohol. 

Universal training as a factor working 
toward the elimination of prostitution can 
be made both direct and indirect. 

It will be direct by the right training of 
the youth toward a clean and productive 
life, and by the encouragement of early 
marriage which a young man properly 
equipped with vocational and educational 



IMPORTANCE OF UNIVERSAL TRAINING 85 

training will be better able to undertake 
than at present. 

It will be indirect by the results of this 
training which lead to early marriage and 
by the graphic lesson which it is possible 
to give of the frightful consequences of 
sexual diseases. 

Having seen then some of the possibil- 
ities of universal training in its influence 
on the social background of these sex in- 
fections, let us see what medical measures 
of practical value could be incorporated 
with such a system of general training. 
For this we need only look back to our 
recent war experience to gather informa- 
tion ; for what we did not learn from prac- 
tice we learned from our mistakes, and the 
linking of the two may be looked upon as 
good ground work for an excellent start. 

In each training camp there must of 
course be a general hospital and, as in our 
recent camps and cantonments, a special 
department for the care of sexual diseases. 
This branch, however, must be managed by 
an expert who has with him trained assist- 
ants. 



86 CONTROL OF SEX INFECTIONS 

The fundamentals of this work must be 
standardized if uniform results are to be 
expected. 

A good many cases of these diseases 
may be looked for, unless a miracle has 
transformed our social state since we 
drafted three or four million young men in 
1917 and '18. But, differing from that ex- 
perience, we should be ready for these 
infections with specialists and adequate 
equipment. In this way those infected will 
not only get the best care possible, but will 
receive a lesson as to what is the proper 
treatment of these diseases. It will be 
possible under universal training to keep 
the infected under treatment until cured 
or freed from their infectiousness ; for this 
can be carried on under government control 
even after their period of training is com- 
pleted. 

Those who are infected during their pe- 
riod of training can receive the prompt 
treatment which assures a cure in many 
cases in a surprisingly short period as com- 
pared with the older methods. Medical 
prophylaxis however should prevent the 



IMPORTANCE OF UNIVERSAL TRAINING 87 

occurrence of many such cases. And as 
we make progress in this campaign along 
educational and social lines the occurrence 
of these disorders should grow less fre- 
quent. 

All young men as they pass through 
their course of universal training whether 
they come infected, or become infected, or 
remain free from infection, will receive 
full instruction (as did certain groups of 
our recent national army lucky enough to 
get where there was some system in this 
department of medicine) both as to the 
nature and danger of these maladies, as 
well as their correct care and avoidance. 
Let the reader pause for a moment to con- 
sider the significance of such a stupendous 
blow at this plague. Think of it! Every 
youth in the land instructed concerning 
these diseases. No social effort, no health 
department service can for many years 
effect in the coming campaign on these dis- 
eases what it is possible to accomplish with 
universal military training, at one blow. 
I think we can conservatively say that no 
single measure at our disposal can accom- 



88 CONTROL OF SEX INFECTIONS 

plish what the universal training system is 
capable of accomplishing in this depart- 
ment of hygiene. 

Let any citizen who for any reason does 
not favor universal training of the youth 
of the land bear this in mind: That the 
economic saving alone in human efficiency, 
if these diseases could be adequately con- 
trolled, would probably almost, if not en- 
tirely, pay the bill for this national system 
of defense and development, once it was 
properly established. 

So much then for universal training of 
the male youth of this country and its pos- 
sibilities in the upbuilding of our national 
manhood as well as the undoing of our 
sexual infections. 

But how about the girls who are grow- 
ing into womanhood? Are they to receive 
no training? Are they to receive suffrage 
and give no service? This is a very perti- 
nent as well as a very important question 
of a most practical nature at this moment 
of social reconstruction. That all young 
women should receive some training in the 
fundamental duties pertaining to the 



IMPORTANCE OF UNIVERSAL TRAINING 89 

woman's sphere is no new thought, for it 
was under discussion long before the great 
war came upon the world, in countries so- 
cially more advanced than our own. In 
the light however of the great social 
changes going on everywhere the idea of 
some suitable form of universal training 
for young women truly lifts before the 
lively mind new levels of hope. To think 
of a womanhood of healthy, strong, trained 
and capable individuals, is to think alto- 
gether in new terms of life ; and this is the 
moment for our minds to bend to thoughts 
wilich carry with them a promise of better 
things for our children. Soon, when the 
present flux of opinion becomes fixed into 
new and rigid conventions again, like the 
broken leg which is badly set, the time for 
a brilliant result will have passed and we 
shall have nothing better than the same old 
crutches to limp along on. It would seem 
worth while then to take a short mental 
excursion into this idea of universal train- 
ing for girls and see if in the interior of 
the thought there is really anything to hold 
our attention. 



90 CONTROL OF SEX INFECTIONS 

Let us say that nine or ten months was 
the period of training which each girl as 
she reaches the age of 16 or 17 years would 
be required to take. 

She would start off with a three months' 
summer period of outdoor camp instruc- 
tion and physical development. The mind 
can easily imagine with what eagerness all 
normal young girls would be looking for- 
ward to this experience; but it would be 
difficult for the mind to measure off-hand, 
what the value of this would be. 

The greater part of the time in this pe- 
riod would be devoted to agreeable physi- 
cal exercises and games in the open; but 
they would be governed by order, punc- 
tuality, fair play and good temper, and the 
principles of discipline would be developed. 
All girls at this period would be learning 
how to care for and look out for themselves. 
They would make their own beds and keep 
their living quarters up to the sanitary 
standard of cleanliness and order. They 
would wear some regulation but simple 
uniform or costume. By their outdoor ex- 
ercises and healthful regime they would 



IMPORTANCE OF UNIVERSAL TRAINING 91 

learn how nature applies her cosmetics to 
complexion, cheeks, eyes and lips — perhaps 
in time the face-paint and powder mer- 
chants would take up some more desirable 
trade and the drug-stores resume the sale 
of drugs. During this period a couple of 
hours a day could be devoted to useful in- 
struction, graphically and thus impres- 
sively given, of a fundamentally and uni- 
versally important character — things that 
every woman should know, such as: 
Health and how to maintain it ; illustrated 
by a little simple physiology and anatomy 
coupled with the principles of bodily hy- 
giene. Food; its values and how to pre- 
pare it, from the standpoint of economy 
and efficiency, as well as the palate. 
Household sanitation and order. Cloth- 
ing; the value of simple and wholesome 
dress. Sexual instruction. The impor- 
tance of physical (including muscular) 
strength and health; as opposed to the 
present average condition and conduct of 
women, which is making motherhood a sac- 
rilege. The processes of impregnation 
and reproduction and the dangers of the 



92 CONTROL OF SEX INFECTIONS 

sexual infections to these and to the child. 
Instruction on social subjects, such as pub- 
lic welfare, order, safety and sanitation. 
Instruction in the principles of government 
and the responsibilities of suffrage. 
Fairly grounded on these subjects women 
can safely sit in Congress. 

During these first three months of bodily 
training, with a little useful information 
— something like the above — added to it, 
a very exact estimate could be made of 
the physical and mental status of each girl. 
This might serve several good purposes, 
but the two most concerning us here would 
be, first, that a reliable statistical record 
would be gained for future guidance in such 
a system of universal training for girls, 
and second, a record which would be of im- 
mediate value in estimating just what prac- 
tical service each girl would be best suited 
for in completing her course of training. 

This second period of training devoted 
to practical work should aim to ultimately 
become of economic value to the Govern- 
ment while serving to train the girl. The 
following might be taken as illustrative of 



IMPORTANCE OF UNIVERSAL TRAINING 93 

such work as would fall within this cate- 
gory : First the arts of housekeeping such 
as cooking, sewing, gardening and the like, 
all of which would be taught on the basis 
of order, cleanliness and economy. The 
reader will not miss the broad field this 
opens up for cultivation. To these things 
a taste for beauty and harmony could ad- 
vantageously be cultivated. 

Outside those domestic duties which aim 
at some perfection of the home lie the ob- 
ligations of social welfare; and here it is 
that the training of the girl would embody 
not only some of the most useful of the 
actual lessons of life ; but it would be here 
also that her service might become of some 
economic value to the Government. In the 
field of social service, in district nursing, 
in the care of babies, in federal, state, and 
municipal hospitals, in diet kitchens and 
many other community institutions these 
young government uniformed assistants 
might for a certain period of their train- 
ing actually become factors of financial 
saving. With the cooperation of the Pub- 
lic Health Nurse a system might be worked 



94 CONTROL OF SEX INFECTIONS 

out whereby a part of the girls' training 
might become a very useful one to society 
at large. This guidance would at least 
give them an insight into what may at pres- 
ent be considered one of the great social 
advancements of the day — that of Public 
Health Nursing. 

In each state the state's facilities for 
social welfare work could be surveyed in 
order to fit in the scheme of universal train- 
ing for girls with that which has already 
been built up for social work within the 
state. It can readily be seen that this 
would of necessity do much to standardize 
this most important public health and edu- 
cational activity. 

During all this period of practical train- 
ing the girls would be under the supervision 
and direction of their commanding officers, 
so to speak. A certain amount of outdoor 
physical exercises would be required, or 
calisthenic exercise inside if climate or 
weather made that necessary; so that the 
habit of muscular activity would be estab- 
lished. They would be required to keep 
neat in their appearance and keep their 



IMPORTANCE OF UNIVERSAL TRAINING 95 

bodies clean, their teeth carefully brushed, 
and all other habits pertaining to bodily 
hygiene firmly fixed. Short courses of in- 
struction to make clear all the work they 
were given to do would be given; and effi- 
ciency records would be kept of each indi- 
vidual, along with her personal, physical, 
and mental status and development. 

Unlike the training of the male youth, 
who would be placed on a reserve basis, the 
girls could be turned back to their homes 
at the end of the training period as having 
graduated from their obligatory service; 
but records of each would be had and in 
case of a national emergency the recruiting 
of trained and efficient assistants would be 
accomplished without difficulty. 

With this annual inventory of our matur- 
ing human values to go forward from we 
could perhaps build the foundation of some 
real national and individual worth. 

The conventionalized parents of some 
girls would at first see difficulties in the 
necessary hiatus in their school curricu- 
lum, but for the great majority it would be 
a great and ennobling finish to the school 



96 CONTROL OF SEX INFECTIONS 

days of their early life and a sound begin- 
ning for their future individual and social 
usefulness. And by our usefulness must 
we largely measure the satisfaction of hu- 
man existence. 

But the reader may justly ask, what has 
this to do with the control of sexual infec- 
tions? As in the male youth of the land 
it would give a universal knowledge as to 
these conditions, and few girls, who actu- 
ally knew what these diseases mean to a 
woman, would lightly jeopardize all the 
health and happiness of life. As probably 
the large majority of prostitutes are what 
they are because they have no knowledge 
or experience of how to take care of them- 
selves and earn a reputable living, one of 
the main reasons for prostitution would 
perish. More women being physically and 
otherwise fitted to be married and make 
good wives, mothers and actual helpmates, 
would undoubtedly be married. After a 
girl has had this socializing benefit, the 
knowledge and physical development as 
well as given an identity through service 
to her country, it is difficult to think she 



IMPORTANCE OF UNIVERSAL TRAINING 97 

would be so apt to fall or be led into prosti- 
tution. So by these and many other ways 
it is not hard to see how universal training 
for the young women would diminish pros- 
titution and the sexual infections, while in- 
suring sexual safety and the promise of a 
better race. 



CHAPTEE VIII 

SYSTEMATIC CARE OF THE SEXUAL 
INFECTIONS 

Here is the logical beginning of this 
whole matter — the reduction of sex disease 
carriers by prompt and proper care. This 
is society's first task; to see that all hos- 
pitals are adequately prepared with a ra- 
tional system and a reliable staff to meet 
the situation which exists in all commun- 
ities. Society's first task; for it is even 
more largely due to society's near-sighted 
taboo than to the indifference of the med- 
ical profession as a whole that means of 
scientifically dealing with these diseases as 
a routine have been so entirely wanting. 
Though in the past many fashionable hos- 
pitals declined to take i i disagreeable ' ' dis- 
eases, such as cancer or syphilis or gono- 
coccus infection and give them beds when 
bed treatment meant everything to the pa- 



SYSTEMATIC CARE 99 

tient's prospects of relief and cure, the fu- 
ture will necessarily be colored by a differ- 
ent policy if we are going to war against 
these veritable enemies of the flesh. For 
it is war upon these diseases, it is to be 
remembered ; not war upon the individuals 
or their morality, or their religion, or their 
occupation, or their class of society; but 
war upon the germ factor of these maladies 
— clean, straight, unprejudiced, scientific 
warfare, which is the first business of the 
hospital and of the physician. Without the 
establishment of trustworthy departments 
for the care of sexual diseases, either as 
independent units as they are now plan- 
ning for in Great Britain, or as special 
services in existing hospitals, there will be 
very little progress made by broad-cast ad- 
vice to infected individuals to go and get 
good medical counsel and treatment. For 
until by institutional experience scientific- 
ally standardized methods are worked out 
and developed there will be no reliable 
standard for physicians at large to live up 
to; and those who know anything about 
medical matters know exactly what that 



100 CONTROL OF SEX INFECTIONS 

means. There are already a large number 
of medical men who can be considered well 
equipped experts in the treatment of sex- 
ual diseases ; but how many of the sex-in- 
fected come under their care first hand? 
If the truth could be known the number 
would prove to be very small. Unfortu- 
nately it is just this first hand treatment 
upon which so much depends. We cannot 
hope for such a fortunate falling out of 
events as would see all the freshly infected 
people of the future coming promptly un- 
der the care of special and experienced 
workers in this department of medicine; 
but we can hope to see the early mishand- 
ling of these ill-favored individuals very 
largely remedied. This will best be 
brought about by setting a standard of 
care in our institutional treatment of 
these cases just as the surgical care for 
the individual with an attack of appendi- 
citis has been developed and become a safe 
routine procedure in the vast majority of 
such cases. When the scientific and suc- 
cessful care of these diseases comes to be 
more or less common knowledge among 



SYSTEMATIC CARE 101 

people generally, the quack quick-cure of 
newspaper advertising fame, the dispens- 
ing drug-store clerk and the spurious 
specialist who have all been consigning 
these cases to the incurable class, will com- 
mence to vanish. When many general 
practitioners at large come to realize that 
the patients themselves have come to learn 
the difference between purposeful, scien- 
tific treatment and a bluff at knowing these 
diseases and how to handle them, they will 
be very apt* (for reasons best known to 
themselves) to either acquire the requisite 
knowledge and skill, or send these patients 
where they can receive proper care. 

More than one curious fact both in the 
medical world and out of it was made evi- 
dent by the war when it threw up upon 
the shore of peace its testimony. When 
the United States emerged from its belli- 
cose experience its medical assets for the 
general care and control of sexual infec- 
tions became painfully plain. While in 
practically all other branches of medicine 
there was some system, some cohesion 
which gave them a useful functioning basis 



102 CONTROL OF SEX INFECTIONS 

with which to do creditable work, the de- 
partment which dealt with genito-urinary 
ills went out of the army and navy service 
very much as it went into it — represented 
by a scattered few. But to that scattered 
few there still clings much valuable memory 
and experience from their work with the 
sexual disease situation which may serve 
society a very useful purpose. 

In giving the following sketch of a sys- 
tematic scheme for the care of sexual in- 
fections which we set up in one of our 
army camp hospitals during the latter part 
of the war it must not be supposed that 
this plan is to be considered the last word 
in the organization of a department for 
these diseases ; but rather is it to be looked 
upon in the light of a simple stepping- 
stone which may serve some small purpose 
in our progress toward a universally use- 
ful standard. It is also to be remembered 
in reviewing this army experiment that no 
such complete control of the situation is 
likely suddenly to be had in any civil com- 
munity under peace-time conditions. 

Before the work was begun the plans 



SYSTEMATIC CARE 103 

were fully laid out by drawings, models 
and description. It was then laid before 
the medical officers of the hospital and 
camp in order not only to get their criticism 
but to get their intelligent cooperation in 
what was such an important phase of army 
medical work; for unless a general under- 
standing of any new organization is had, 
the objective aimed for is not apt to be 
reached. While it was with the idea of 
putting the collective care of these infec- 
tions on an orderly basis, there were three 
specific purposes which were set down as its 
special goal. First, the importance of put- 
ting these diseases under treatment at the 
earliest possible period of their onset. 
Second, the employment of means which 
would materially shorten the period of in- 
fection. Third, to get a more definite as- 
surance as to the completeness of cure. 
All of which has been previously much neg- 
lected. 

The first purpose was made very plain 
to all medical officers who were apt to see 
these cases in the field. In cases of a 
doubtful genital sore (nearly all genital 



104 CONTROL OF SEX INFECTIONS 

sores are doubtful) the danger of any anti- 
septic application or treatment which ruins 
the dark field microscopic diagnosis of 
syphilis was emphasized, and directions to 
send immediately all such cases to the 
genito-urinary service in the hospital was 
made very clear. In cases of any urethral 
discharge or complaint of premonitory 
symptoms, all such (without temporizing 
treatment) were to be promptly sent to the 
genito-urinary department. 

This matter of getting at these patients 
at the earliest possible moment of their dis- 
ease is here especially stressed, because 
upon this opportunity alone is built all that 
is most useful in any systematic plan of 
care. An individual who loses the chance of 
treatment during the first few days or the 
first week of his or her gonorrheal dis- 
charge, or the one who has a genital sore 
and is not treated immediately, loses the 
high opportunity of a short period of infec- 
tion, and loses the opportunity for the 
definite cure which only this early entrance 
upon treatment can assure. Let there be 
no misunderstanding about the importance 



SYSTEMATIC CARE 105 

of getting the proper treatment, at this 
first moment, of a sexual disease; for it 
is at this point in the sex disease road that 
ruin has been spelled out for the vast num- 
ber by the individual's ignorance, or by the 
quack, or the drug clerk, or some other in- 
dividual who is not qualified to care for 
these cases. 

In the establishing of this army depart- 
ment three buildings approximating three 
hundred beds and ample room space for 
examinations, records and treatment were 
placed at the disposal of the chief of the 
service, and let me say, that in this instance 
all the equipment required was as promptly 
as possible provided. 

To draw a finely detailed picture of this 
department in full action would dispropor- 
tion this little book, and perhaps not leave 
the essentials quite as clearly emphasized 
in the reader's mind, as a view more or 
less in perspective with the important and 
newer features in the foreground. 

Order and cleanliness were the first 
favors to be bestowed on this department. 
The time-honored tradition of "the worst 



106 CONTROL OF SEX INFECTIONS 

is too good for those patients" was 
promptly erased from the minds of any 
workers on this service who showed linger- 
ing traces of this former plan of treatment. 
It was made very plain that these patients 
were to be treated precisely as any other 
sick patients and their problems of sick- 
ness approached in exactly the same scien- 
tific spirit and humane manner as any 
other human ills. The result of this was 
no small item in our net receipts of pro- 
gress and improvement, and it brought out 
a real interest in the pathological study of 
these diseases. Under this plan the doc- 
tors and nurses soon became as keen as if 
a lot of new diseases had suddenly been 
discovered. 

Before the professional business of the 
day was begun in each one of these hun- 
dred bed buildings, a short standing con- 
ference called the "line up," was held. 
All the workers in that building, ward sur- 
geons, nurses, ward men, etc., came to- 
gether and lined up according to rank on 
each side of the large square entrance hall. 
This assembly served a number of pur- 



SYSTEMATIC CARE 107 

poses: We started the day by a "good 
morning, ' ' we saw that all were present 
and in working order. Eeports from de- 
partment heads were heard. Each one 
had a chance to offer a suggestion or voice 
a grievance. There was no secret diplom- 
acy ; we all knew just what we were head- 
ing for. In this way we all did our work 
happily, and got results. These " line- 
ups " usually lasted but a few minutes; in 
fact they were time limited as we went on 
a time schedule. After the conference, in- 
spection of the building and all that it con- 
tained, was made. By going from one to 
the other of the three buildings these duties 
were gotten out of the way before nine 
o'clock when professional rounds were be- 
gun. In carrying the reader with me on 
these rounds special attention will be called 
to such innovations as were instituted to 
simplify and make more effective the care 
of these diseases. 

Starting with the building for the treat- 
ment of syphilis, chancroid and skin dis- 
eases: In the care of syphilis certain 
wards were assigned for the different 



108 CONTROL OF SEX INFECTIONS 

stages and types of this infection. Early 
cases with open and obvious lesions were 
placed in one ward. It was possible thus 
not only to isolate these patients in their 
most infectious period, but to obtain group 
studies of the disease in this way. The 
recording was simplified;, the individual 
cases were better kept in memory and the 
results of treatment were more clearly dem- 
onstrated. When these patients had pro- 
gressed to a stage of ordinary noninfec- 
tiousness, their mucous membrane lesions 
healed and their skin clear, they were 
graduated to another ward with more free- 
dom. Now it was this typical early class 
of cases which constituted a group with the 
best opportunity for complete cure. But 
just what constitutes the right treatment 
for a complete cure has never been exactly 
determined ; with the result that even with 
a typical class of cases no exactness in 
dosage or drugs or regime has ever been 
made a general rule. The consequence of 
this has been in institutional or collective 
care of these patients by what we might 
call the "temperamental method" where 



SYSTEMATIC CARE 109 

each patient is treated from time to time, 
as it were, according to the particular 
fancy or inclination of this or that medical 
attendant, that some patients have doubt- 
less gotten very complete cures with a mini- 
mum waste of time and material; but the 
numbers who are missing this desirable 
eventuality must be appallingly great by 
the usual hit or miss " temperamental 
method. ' ' 

It was for this reason that we instituted 
for this class of patients the formula called 
Standard Syphilis No. 1, which was built 
up from methods of treatment in the 
British Army and from recommendations 
made by our own army Medical Depart- 
ment (see next page). 

With this formula will be seen the pro- 
cedure followed in all ordinary early cases. 
It has a number of advantages hitherto 
not included in any single formula for the 
care of syphilis. Into its category can 
come the bulk of the early cases. 

Once it has been decided on for the pa- 
tient, that patient, theoretically speaking, 
is there and then assured a cure — a very 



110 CONTROL OF SEX INFECTIONS 



STANDARD SYPHILIS NO. 1 

A routine course of treatment for ordinary fresh cases of 
syphilis in otherwise healthy men (to be interrupted in the 
event of dermatitis, jaundice, or other signs of intolerance 
supervening). Each patient to be carefully scrutinized for 
signs of stomatitis or general malaise, his weight to be 
taken, and his urine tested before each injection. 

In conjunction with the employment of this course of 
treatment, each medical officer shall be familiar with * 'Pro- 
posed Modification of Circular No. 14, W. D., Office of the 
Surgeon-General." 

Patients are to be treated at base hospital until open le- 
sions are healed, when they will be sent to development bat- 
talion or regimental surgeon for completion of treatment. 

The scheme of arsphenamin dosage is based on 150 pound 
men, or 1 decigram to about 30 pounds of body weight. 

Mercuric Salicylate, 
33 Per Cent. 

Arsphenamin in Olive Oil. 

(Intravenously) (Intramuscularly) 

Gm. Grains. 

First day 0.3 1.0 

Sixth day 0.4 1.0 

Eleventh day 0.4 1.0 

Eighteenth day 0.6 1.0 

Twenty-fifth day 0.6 1.0 

Thirty-second day 0.6 1.0 

Thirty-ninth day 1.0 

Forty-sixth day . . 1.5 

Fifty-third day 1.5 

One month rest, then take Wassermann: If positive, re- 
peat entire course; if negative, repeat the mercury alone. 

At the end of the second course, rest two months; then 
take Wassermann, and give third course in accordance with 
rule for second course. 

During second year, if Wassermann is positive repeat en- 
tire courses as above. If negative give two mercury courses 
with four months between. 



SYSTEMATIC CARE 111 

momentous thing for not only the individ- 
ual but for society. Practically speaking, 
however, we do not at all know that it is 
the best treatment in the world. What the 
best treatment is going to prove to be will 
only be discovered by some such theoretical 
basis which we start from and stick to long 
enough and faithfully enough to get results 
upon which judgment can be passed. Per- 
haps long before then a protective vaccine 
will forestall that judgment. 

The effect on the patient of being 
launched with a reliable ticket which 
should carry him safely to the end of his 
course proved a very happy thing. The 
formula was posted so that all officers, 
nurses and patients could read, understand 
and become familiar with just what was to 
be expected. The interest which each pa- 
tient took was remarkable, and the readi- 
ness with which he cooperated only attests 
further the advantage of mutual under- 
standing in the furtherance of mutual un- 
dertaking. 

On the progress sheet of the record the 
formula was rubber stamped and checked 



112 CONTROL OF SEX INFECTIONS 

off by the medical officer as he gave the 
treatments. The simplicity of this record 
made it readable at a glance. 

With this formula the surgeon's obliga- 
tion to see his patient through is immensely 
lightened by having so many steps in a 
long and wearisome course of treatment 
decided at one stroke. 

The results of this treatment as far as 
we went were highly satisfactory and as 
the patients were discharged from the hos- 
pital their syphilitic register was stamped 
with the formula Standard Syphilis No. 1, 
with the hope that they would fall into the 
hands of those who would continue its 
course. 

Of the atypical cases of syphilis, the 
chronic cases and those complicated by vis- 
ceral diseases there is little to be said here, 
beyond the fact that they were carried 
along in the general orderly system under 
such individual treatment as seemed indi- 
cated. Neither did the cases of skin dis- 
eases fall under any formulated class treat- 
ment as did the early cases of syphilis, 
chancroid and gonococcus infection. 



SYSTEMATIC CARE 113 

The chronic, complicated and crippled 
cases of gonorrhea like the advanced syph- 
ilitic received such accredited treatment as 
seemed best suited to the individual prob- 
lem, and all of this is adequately dealt with 
in text books on this subject. It is beyond 
the boundary of this book, which essays to 
deal with the topic of control of sexual 
infections, to go into the discussion of those 
cases which are the fruits of our past in- 
difference and neglect. They should have 
all the humane and scientific attention 
which we can give them; and we should 
see to it that their likes are not repeated 
in the future. 

The early cases of chancroid were put 
into their class group and treated by means 
of constant cleanliness and exposure to sun- 
shine. This rapidly healed the majority 
of these cases. From the chancroid group 
we constanly reclaimed cases of syphilis; 
for of these cases which were closely fol- 
lowed up with "dark field " examinations 
a surprisingly large number were found to 
be thus doubly infected. 

Of all the problems difficult to face in a 



114 CONTROL OF SEX INFECTIONS 

satisfactory scheme of treatment for the 
sexual diseases, that of an effective treat- 
ment for gonococcus infection must be 
placed first. 

Here is a disease without a specific drug, 
vaccine or certain remedy. Eeliable au- 
thorities estimate that only a little more 
than one out of ten cases in the male are 
cured without an invasion of the posterior 
urethra and the integrity of the genital 
glands being violated. The occurrence 
which spells months or years of infectious- 
ness, and all too often permanent destruc- 
tion of tissues. 

Sixty to eighty per cent, of all sexual in- 
fections are gonorrhea. 

It is said to be the most widespread and 
universal disease affecting the adult male 
population. It is further said that 
seventy-five per cent, or more are at some 
time infected. It provides the majority of 
all pelvic operations on women, many of 
which destroy their sex or render them 
permanent invalids. 

The best clinical observers of this dis- 



SYSTEMATIC CARE 115 

ease place fifty per cent, of the involuntary 
childless marriages at its door. 

More than twenty-five per cent, of all the 
blindness is due to it. It is probably the 
cause of more social destruction than any 
other disease, not excluding tuberculosis. 
By such tokens, then, can the gravity of this 
disease be estimated and the importance 
of its purposeful care be measured. 

And so it was that an adventure into a 
formulated procedure of treatment for this 
disease became of peculiar interest; for 
it was with all these things in mind that 
the building with a hundred beds for an 
experiment in the care of this disease was 
begun. 

We can set aside the treatment of the 
chronic and complicated cases with a few 
words. They were cared for with all the 
well known and well tried modes of treat- 
ment that had gained for themselves some 
clean-cut claim to merit, and by these 
means an effort was made to remove, as 
far as possible, from these scarred and 
strictured and generally outraged tissues, 



116 CONTROL OF SEX INFECTIONS 

the infection present. Besentful as one 
often becomes at this vast army of recur- 
ring chronics, these uncured and compli- 
cated cases which stumble on from one 
stage to another, it is hardly fair at pres- 
ent to put these cases all down to the 
blunders of either medical misattention or 
blame the patients themselves while no 
suitable standard for the successful care 
of the early infection has yet become gen- 
eral. 

As in the department for syphilis the 
cases of gonorrhea were separated in dif- 
ferent wards according to their type or 
complication. For the examination and 
treatment of these cases in groups a large 
room was equipped. Down one side, but 
free in the room, ran a trough where fifteen 
patients could receive at one time either 
injections or irrigations, each one being 
under the direct observation of a medical 
officer as he passed along in front of the 
patients under treatment. In this manner 
it was possible to see that each learned the 
proper method of his treatment. Tables 
were there for those groups receiving 



SYSTEMATIC CARE 117 

instrumental treatment. Those receiving 
massage of prostate and vesicles had their 
progress checked up by immediate micro- 
scopic examinations. The strictest surgi- 
cal cleanliness was observed in all treat- 
ments. One room was equipped solely for 
the two- or three-glass tests which were 
checked up and recorded every morning 
with the first urination — there being a hun- 
dred pairs of urine glasses on shelves 
marked with their equivalent bed numbers. 
Twice each week smears were taken from 
each patient's urethra before urination, 
were Gram stained, were studied and re- 
corded. The records were simplified to 
the last degree so that the patient's pro- 
gress could be read at a glance. Any 
reader who would be interested to see this 
service more fully described and illustrated 
by pictures is referred to the Journal of 
the American Medical Association of April 
26, 1919. 

Letting this abridged sketch of the de- 
partment for the care of gonococcus infec- 
tion in its various stages serve as a back- 
ground, we can turn our attention to the 



118 CONTROL OF SEX INFECTIONS 

formulated or special treatment alluded 
to. Here it was that we were to embark 
on an adventure into the realm of the gono- 
coccus which was somewhat of a departure 
from the usual day to day prescribing 
method of treatment. 

The direct object of this experiment was 
to see what proportion of these patients it 
was possible to bring to a complete and 
early cure before the gonococcus had in- 
vaded to any extent the urethral glands or 
follicles or extended back of the mem- 
branous urethra which guards the openings 
of the prostate gland and seminal ducts. 

To this end the uniform treatment was 
adopted which went by the name of Stand- 
and Gonorrhea No. 1 (see next page). 

A brief study of this shows it to be a 
succession of safe and simple steps, marked 
off into periods or phases ; but only by thus 
standardizing some plan and carefully pur- 
suing it is it possible to tell by what means 
the disease can most successfully be treated 
and brought under control. 

That it is only applicable to the early 
cases should not need further emphasis. 



SYSTEMATIC CAKE 119 



STANDARD GONORRHEA NO. 1 

A routine course of treatment for ordinary, early and un- 
complicated cases of gonorrhea in otherwise healthy men. 
Employed at base hospital and continued at development 
battalion or by regimental surgeon (to be interrupted in 
event of complications or intolerance). 

DURING FIRST TWO WEEKS 

In bed from four to eight days, then "up" if inflammation 
has subsided. Bland diet. Two glass test each morning 
with first urination. Smear on Monday and Thursday morn- 
ings, before urination. Sandalwood oil, 5 minims three times 
a day, and increase 5 minims daily until 15 minims three 
times a day, after eating ; then decrease 5 minims daily. 
Irrigation twice daily (at 5 feet, patient standing) with po- 
tassium permanganate, 1:8,000, from 105° to 115° F. The 
irrigation not to be "through," i. e., into the bladder, until 
the patient can relax without the slightest discomfort. Hand 
injections to be used while infection remains anterior. 

DURING SECOND TWO WEEKS 

Bland diet continued. Patient should be up all day, and 
doing from two to four hours of light work. Two glass test 
and smear as before. Do not repeat Sandalwood oil course, 
if improvement is marked as it should be. Irrigation twice 
daily as before, with potassium permanganate solution, 
1:6,000 at 6 feet, or hand injections if infection is still 
anterior. 

DURING THIRD TWO WEEKS 

Diet bland, but increased. Patient should be having 
from three to six hours daily of light work. Two glass test 
and smear as before. If any discharge or cloudiness of 
urine is present, potassium permanganate, 1:4,000 irriga- 
tion. 

When free from symptoms (no discharge and clear urine) 
for two weeks, without treatment, and doing from three to 
six hours' work daily, the patient in most cases may be con- 
sidered fit for duty and infection free. 

Note — In seeking a useful basis of treatment for the ordi- 
nary run of gonorrheal cases it can be easily understood 
that no lesson of value can be learned unless the plan laid 
down is followed accurately in every detail. 



120 CONTROL OF SEX INFECTIONS 

It will be the obligation of a more enlight- 
ened future to see that the opportunity of 
this first moment of the disease is not 
missed. It was not used in cases which had 
existed upward of two weeks, or in recur- 
rent cases. The formula was strictly ad- 
hered to as it was originally drafted, ex- 
cept for the fact that no local treatment 
(injections) was begun until two or three 
days in bed had abated the existing acute- 
ness of inflammation. 

The progress sheet of the record was 
ruled off into columns describing daily the 
discharge, urine, presence of gonococci and 
other remarks. It could be read by a look. 

The result of this treatment turned out 
to be far more satisfactory than was our 
expectation, in so far as we were able to 
follow our cases discharged as cured; and 
this we were able to do, with some of them, 
for many months. 

The curative results of this treatment 
were based on the following tests : 

1. Before being taken off treatment: 
(a) no discharge: (b) a clear urine: (c) 
gonococcus free for a period of ten days. 



SYSTEMATIC CARE 121 

2. With no treatment; with no restric- 
tion of activity; with no signs of disease 
for two weeks. 

The average time of cure, which included 
the two weeks' period of observation, was 
from five to six weeks. 

So far as we could tell, none of these 
patients had a recurrence. 

The best results were in those cases 
where there had been no previous infection 
and where treatment was begun during the 
first week of the disease. Of these 90 per 
cent, were returned to duty cured. In all 
of these cases the infection was cured with- 
out extending into the posterior urethra. 
Unfortunately there were only a small 
number of these cases for this study. Only 
twenty in the first week of disease. Of 
those cases where the treatment was begun 
during the second week of the disease the 
per cent, of cures dropped to 80 per cent, 
in this average period of from five to six 
weeks' care. 

These unusual results of what is prac- 
tically a reversal of the established statis- 
tical estimate of cures before the infection 



122 CONTROL OF SEX INFECTIONS 

had extended from the anterior to the pos- 
terior urethra, we felt was in part due to 
the excellent general condition of these 
soldier patients who were leading a vigor- 
ous outdoor existence. But the chief fac- 
tor of success is first of all the rest in bed. 
This can not be minimized, and it is im- 
possible to lay too much stress on the im- 
portance of this measure in every case seen 
within the first two weeks of the disease. 
Until we have some specific remedy for this 
infection it is the physician's duty to so- 
ciety as well as to the patient to see that 
this essential requirement is complied with 
in all early cases of this disease which he 
sees. 

Probably the next most important ele- 
ment in this standardized treatment is the 
conscientiousness and care with which it 
is carried out. This has a twofold advan- 
tage. It assures in capable hands the thing 
being well done, and it assures the full con- 
fidence of the patient. As for the local 
treatment of injections we have no certain 
remedy, as is well known, but the important 



SYSTEMATIC CARE 123 

thing is to do no harm with such remedies 
as we have. 

Though the results of Standard Gonor- 
rhea No. 1 chanced to be brilliant the plan 
itself required no special intelligence. It 
was the painstaking sincerity of the young 
medical officers who carried this plan out 
which deserves credit for its success. 

To many medical men this treatment will 
undoubtedly seem impracticable, so long 
has it been the custom to treat this disease 
merely with things and not with thoughts 
— merely by the motion of the hand, but 
without any motion of the brain — that the 
matter of its care has fallen into a lazy 
reflex act performed without a thought of 
the tragic train of consequences which this 
kind of callous treatment brings about. 

What our medical friends really mean 
when they say it is impracticable is that it 
is too much trouble ; but none whose minds 
are capable of measuring the human cost 
incident to gonococcus infection can fail 
to know that a cure of this disease at any 
cost is cheap. So many doctors cry: 



124 CONTROL OF SEX INFECTIONS 

"But we cannot put these patients to bed! 
— They must keep on work! — Their fami- 
lies would know! — They will not submit!" 
Oh, great physician, where has your author- 
ity gone? Do you look to please your pa- 
tient or to cure him? Are you looking for 
his dollars or his deliverance ? If you are 
truly working for your patient's interest 
you will spare no time or pains in show- 
ing him the truth and seeing to it that he 
goes to bed, and in all other matters fol- 
lows your advice. It is better that a doc- 
tor goes hungry treating three patients a 
day properly than that he roll around in a 
luxurious motor pleasing thirty. 



CHAPTER IX 
MAN'S OBLIGATION TO SOCIETY 

Not infrequently is the statement made 
by an individual that the world owes him 
or her a living. When put by anyone in 
the form of a question, the answer can be 
unequivocally in the affirmative ; for biolog- 
ically it is so, the world does indeed owe 
all its creatures a living, if they are born 
with the vitality to gather it amidst the 
hazards of the process. But when an in- 
dividual means that society owes him a liv- 
ing, that is a very different matter; for so- 
ciety is an association, or if you choose a 
club, in which the eligible must pay their 
proportionate way in good manners, fair 
dealing, and taxation or dues to defray the 
necessary expenses incident to such an ad- 
vantageous membership. 

This then brings us by a very direct route 

125 



126 CONTROL OF SEX INFECTIONS 

to man's obligation to society; and to ad- 
venture into this field for a few moments 
may not be without advantage. 

If this is so, if the nation can be called 
a club or mutual association, and states 
and cities and so on, subdivisions of this 
mutual benefit idea, and really not an arena 
for riot, a field for fighting one another's 
endeavors, a place of political plotting for 
private gains, an opportunity to profit by 
oppressive means; then we gain at once a 
very good notion of just how well we are 
managing this national club of ours today. 

A well run club with an acceptable list 
of by-laws and composed of carefully 
chosen members who remain in good stand- 
ing so long as they are well mannered, 
play fair, pay their dues and contribute 
their share to the upkeeping of their insti- 
tution, goes far to justify its existence and 
set a standard for all other social organi- 
zations. It does more ; by being just and 
by sticking to its rules it forms a habit of 
good order and understanding which robs 
its members of dissatisfaction or distrust. 

Such a self-respecting association pro- 



MAN'S OBLIGATION TO SOCIETY 127 

vides a very good example to keep in the 
mind of the citizen of a nation, state or 
smaller community; but unhappily a very 
different idea has come to take the place 
of this desirable conception of human so- 
ciety. So different an idea indeed of our 
social organization has become fixed in the 
minds of such a considerable number of 
its members that no thoughtful person 
dares to put these ideas down to mere illu- 
sions. We here in America may say these 
unfortunate results of our well intentioned 
beginnings are biological reactions and can- 
not be otherwise ; but it is too easy thus to 
argue out our present state of psychic ill- 
health, or evade the obligations which our 
former neglect or lack of judgment have 
entailed. Starting from, or rather start- 
ing with, our declared independence as a 
nation which was set up in the midst of the 
greatest plethora of natural resources 
came the birth of a mechanical era full of 
the greatest promise of material plenty. 
As time went on, in order to haul these 
riches out of the earth or from the field 
to factory or foundry and from thence to 



128 CONTROL OF SEX INFECTIONS 

distribute them it required a great human 
herd of helpers. 

At this point in our eagerness for gain 
we became blind to the first requisite of a 
well ordered association for the mutual 
benefit of all, and lowered the bars to mem- 
bership by omitting to inquire into the 
qualifications of our new members, in fact 
we did not want them as members at all, 
but so eager for their wage work were 
we that we told them we did, and that they 
must make themselves at home and con- 
sider themselves as equals in our club. 
Thus was the first rotten beam laid in the 
foundation of our "free" society. With 
all these multiplying multitudes of alien 
races wresting riches out of the ground and 
in the factory for us, a great opportunity 
of political "progress" became possible — 
these people who were unfit as "club mem- 
bers" all became good for at least one vote. 
Another beam in our national structure. 

Any active minded reader can continue 
this process of "constructive policy" until 
he has our present "club" house fully 
completed, and looks with pride upon the 



MAN'S OBLIGATION TO SOCIETY 129 

handicraft and art entering into its com- 
position. It is with a " close-up" here and 
there at our society that man can best pro- 
portion out what his obligations in that di- 
rection are. It is in this social state that 
the roots of the sexual infections find such 
a suitable soil. In discussing the control 
of these evils it is necessary then for us 
to acquaint ourselves with the sources of 
their nourishment. 

If we are to gain control of these degen- 
erating sexual diseases man's obligation to 
society must show itself in more than a 
passive role. In this period of social re- 
construction it will be necessary to build 
our social structures up from a firmer base. 
Certain fundamental laws of nature will 
needs also to be recognized. The idea that 
we can repress the sexual instinct for the 
purpose of more profitably pursuing our 
industrial and commercial aims, will need, 
along with a number of other ideas as to 
human instinct satisfactions, a profound 
remodelling. 

At this moment of opportunity for the 
masses the long suppressed instincts of this 



130 CONTROL OF SEX INFECTIONS 

large segment of society are showing them- 
selves in a number of interesting ways, 
which bids fair to undo, and perhaps with 
violent manifestations, what we had accus- 
tomed ourselves to term as either progress 
or profit. 

The natural pride of self-support, of self- 
respect, of good workmanship and many 
other traits to be ascribed as normal, have 
received a serious set-back as shown by the 
present stocktaking of an over-industrial- 
ized era. At present society is seriously 
sick. The war may be looked upon as a 
complicating coincidence of the disease. 
The past century of gorging, — of mechani- 
cal feeding, has fouled the digestive tract 
of our poor social body while it has left 
unused or shamefully abused other vital 
functions of its instinctive life. 

All this points plainly enough to the 
need of a better general social health be- 
fore the ravaging results of its sexual ills 
can be successfully brought to bay. 

But society is the individual — the social 
state is the individual state — so that if we 



MAN'S OBLIGATION TO SOCIETY 131 

are going to obtain real results in the es- 
sential riddance of these infections — each 
one must have some clear cut impression 
of his or her part in the matter. 

Thus, those for example, who having 
read through the chapters of this small 
book, fragmentary and incomplete as it is, 
must through its testimony have come to 
a larger sense of their personal part and 
their unavoidable obligation. 

One cannot view with quiet unconcern 
the war-made records of these diseases, 
and knowing what is inevitably in store for 
the children of the next generation, quietly 
fold the hands and look on unmoved. 

No normal parents who have come to a 
real knowledge of the costly system of si- 
lence on the subject of sex with their chil- 
dren can easily pursue the old customs of 
sham in the future. 

Clergymen and all other ministers and 
teachers of the young coming to realize 
the enormous amount of suffering due to 
their default of this subject will hardly be 
satisfied to sit on in silence. 



132 CONTROL OF SEX INFECTIONS 

We are in court, on trial before the 
children, whose lives have been laid waste 
by these sexual infections. 

It is hard to imagine any excuse which 
will be acceptable for this neglect of man's 
obligation to society. 



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